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Organization
TIKI STAFFORD
Active
Organization
TIKI STAFFORD
Active
Other names
Diversity Me
Organization subpart
No
Provider details
NPI number
Authorized official
TIKI STAFFORD (ADMINISTRATOR)
(904) 233-1090
Entity
Organization
Contact information
Practice address
3225 N MYRTLE AVE, JACKSONVILLE, FL 32209-4231
(904) 233-1090
Mailing address
3225 N MYRTLE AVE, JACKSONVILLE, FL 32209-4231
(904) 233-1090
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11951
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004414400
—
FL
Enumeration date
12/28/2017
Last updated
12/28/2017
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