Organization
AGENCY ONE PROVIDER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICKY RENEE GREEN (PRESIDENT)
(904) 651-8325
Entity
Organization
Contact information
Practice address
3380 CATAMARAN WAY, JACKSONVILLE, FL 32223-7362
(904) 651-8325
(904) 880-1387
Mailing address
3380 CATAMARAN WAY, JACKSONVILLE, FL 32223-7362
(904) 651-8325
(904) 880-1387
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
677817896
PROVIDER ID
FL
Enumeration date
06/30/2009
Last updated
06/30/2009
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