# AGENCY ONE PROVIDER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265660054
- **Authorized official:** MRS. VICKY RENEE GREEN (PRESIDENT)
- **Authorized official phone:** (904) 651-8325

## Contact information

- **Practice address:** 3380 CATAMARAN WAY, JACKSONVILLE, FL 32223-7362
- **Practice address phone:** (904) 651-8325
- **Practice address fax:** (904) 880-1387
- **Mailing address:** 3380 CATAMARAN WAY, JACKSONVILLE, FL 32223-7362
- **Mailing address phone:** (904) 651-8325
- **Mailing address fax:** (904) 880-1387

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 06/30/2009
- **Last updated:** 06/30/2009