MEDICARE: 3D BRIGHTER HOPE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659996999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3D BRIGHTER HOPE CARE LLC

Provider Business Mailing Address
First Line	:	2946 W 6TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-1904
Country	:	US
Telephone Number	:	904-482-7942
Fax Number	:

Provider Business Practice Location Address
First Line	:	2946 W 6TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-1904
Country	:	US
Telephone Number	:	904-444-3802
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASMINE NICOLE MAYS
Credential	:
Telephone Number	:	904-482-7942

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	03/28/2022

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