# COFFEE & GRACE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1750988895
- **Authorized official:** MRS. ALYSSA JACOBS (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (904) 474-2192

## Contact information

- **Practice address:** 1821 N PEARL ST STE A, JACKSONVILLE, FL 32206-3663
- **Practice address phone:** (904) 474-2192
- **Practice address fax:** (904) 212-0128
- **Mailing address:** PO BOX 77581, JACKSONVILLE, FL 32226-7581
- **Mailing address phone:** (904) 474-2192
- **Mailing address fax:** (904) 212-0128

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 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