MEDICARE: LAWANA RILEY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251G00000X	Community Based Hospice Care Agency
2	372500000X	Chore Provider
3	372600000X	Adult Companion
4	3747P1801X	Personal Care Attendant
5	376J00000X	Homemaker
6	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
7	251E00000X	Home Health 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	:	1851066492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWANA RILEY

Provider Business Mailing Address
First Line	:	7253 KOLEDA DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2648
Country	:	US
Telephone Number	:	904-258-4328
Fax Number	:

Provider Business Practice Location Address
First Line	:	7253 KOLEDA DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2648
Country	:	US
Telephone Number	:	904-258-4328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	08/16/2021

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Directions to “ LAWANA RILEY ” Practice Location

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