Organization
COMPASSIONATE CAREGIVER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLORIA ANN MILLER (ADMINISTRATOR)
(904) 398-0734
Entity
Organization
Contact information
Practice address
2217 PERRY PL, JACKSONVILLE, FL 32207-3465
(904) 398-0734
(904) 398-0734
Mailing address
2217 PERRY PL, JACKSONVILLE, FL 32207-3465
(904) 398-0734
(904) 398-0734
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
AL11371
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6930506 96
MEDICAID WAVIER PROVIDER
FL
Enumeration date
09/21/2008
Last updated
01/07/2009
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