Organization
ODOMS TLC HOMECARE SERVICE
Active
Other names
ODOMS TLC HOMECARE SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
LOLITA BURNNETT ELLIS (MEDICAID PROVIDER)
(904) 362-2487
Entity
Organization
Contact information
Practice address
1600 LANSDOWNE DR APT 609, JACKSONVILLE, FL 32211-9010
(904) 362-2487
Mailing address
1600 LANSDOWNE DR APT 609, JACKSONVILLE, FL 32211-9010
(904) 362-2487
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024241200
—
FL
05
—
10179500
—
FL
Enumeration date
02/18/2020
Last updated
02/18/2020
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