Organization
AGNES STREET HOME FOR THE ELDERLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ATAKELTE ADMASU (OWNER/ADMINISTRATOR)
(904) 766-7651
Entity
Organization
Contact information
Practice address
1346 AGNES ST, JACKSONVILLE, FL 32208-3302
(904) 766-7651
(904) 766-7668
Mailing address
1346 AGNES ST, JACKSONVILLE, FL 32208-3302
(904) 766-7651
(904) 766-7668
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL5745
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142605200
—
FL
Enumeration date
05/31/2013
Last updated
05/31/2013
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