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Organization
COFFEE & GRACE LLC
Active
Organization
COFFEE & GRACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALYSSA JACOBS (CHIEF EXECUTIVE OFFICER)
(904) 474-2192
Entity
Organization
Contact information
Practice address
1821 N PEARL ST STE A, JACKSONVILLE, FL 32206-3663
(904) 474-2192
(904) 212-0128
Mailing address
PO BOX 77581, JACKSONVILLE, FL 32226-7581
(904) 474-2192
(904) 212-0128
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
163WH0200X
Home Health Registered Nurse
—
NULL
163WH0200X
Home Health Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
NULL
164W00000X
Licensed Practical Nurse
—
—
251E00000X
Home Health Agency
Primary
—
NULL
251J00000X
Nursing Care Agency
—
NULL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NULL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
NULL
Other
Enumeration date
10/01/2020
Last updated
10/31/2020
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