# DUESEASON1

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

## Provider details

- **NPI number:** 1346733185
- **Authorized official:** TONYA HALL (MEMBER)
- **Authorized official phone:** (904) 504-8855

## Contact information

- **Practice address:** 4058 SAINT AUGUSTINE RD, JACKSONVILLE, FL 32207
- **Practice address phone:** (904) 504-8855
- **Mailing address:** 731 DUVAL STATION RD STE 107, JACKSONVILLE, FL 32218-0801
- **Mailing address phone:** (904) 504-8855
- **Mailing address fax:** (904) 683-9670

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | — | NULL | — |
| 163WH0200X | Home Health Registered Nurse | — | — | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 06/06/2018
- **Last updated:** 06/13/2018