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Organization
ODOMS TLC HOMECARE SERVICE
Active
Organization
ODOMS TLC HOMECARE SERVICE
Active
Other names
ODOMS TLC HOMECARE SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
LOLITA BURNNETT ELLIS (MEDICAID PROVIDER)
(904) 362-2487
Entity
Organization
Contact information
Practice address
1600 LANSDOWNE DR APT 609, JACKSONVILLE, FL 32211-9010
(904) 362-2487
Mailing address
1600 LANSDOWNE DR APT 609, JACKSONVILLE, FL 32211-9010
(904) 362-2487
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
NULL
376K00000X
Nurse's Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024241200
—
FL
05
—
10179500
—
FL
Enumeration date
02/18/2020
Last updated
02/18/2020
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