Organization
LARUE ESTATES
Active
Other names
LaRue Estates
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNEL GRIGGS (OWNER)
(904) 370-3575
Entity
Organization
Contact information
Practice address
8426 DELAWARE AVE, JACKSONVILLE, FL 32208-2841
(904) 370-3575
(904) 683-0147
Mailing address
8426 DELAWARE AVE, JACKSONVILLE, FL 32208-2841
(904) 370-3575
(904) 683-0147
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508222076
—
FL
Enumeration date
12/04/2017
Last updated
12/04/2017
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