Organization
PHENOMENAL HEALTHCARE, LLC
Active
Other names
Home Care for the 21st Century- Jacksonville
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENA ELLIS (PRESIDENT/TREASURER)
(904) 438-5837
Entity
Organization
Contact information
Practice address
6815 ATLANTIC BLVD STE 3, JACKSONVILLE, FL 32211-8764
(904) 438-5837
Mailing address
6815 ATLANTIC BLVD STE 3, JACKSONVILLE, FL 32211-8764
(904) 438-5837
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
03/05/2021
Last updated
03/08/2022
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