MEDICARE: CANARYCHIC ENTERPRISES, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251X00000X	Supports Brokerage Agency
3	253Z00000X	In Home Supportive Care Agency
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1730039587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANARYCHIC ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	15828 BAINEBRIDGE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5218 JAMMES RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7700
Country	:	US
Telephone Number	:	904-442-7500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. LESLIE PENNINGTON
Credential	:
Telephone Number	:	904-299-9198

Provider Enumeration Date	:	01/31/2026
Last Update Date	:	01/31/2026

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