Organization
DUESEASON1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA HALL (MEMBER)
(904) 504-8855
Entity
Organization
Contact information
Practice address
4058 SAINT AUGUSTINE RD, JACKSONVILLE, FL 32207
(904) 504-8855
Mailing address
731 DUVAL STATION RD STE 107, JACKSONVILLE, FL 32218-0801
(904) 504-8855
(904) 683-9670
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
—
—
251E00000X
Home Health Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
06/06/2018
Last updated
06/13/2018
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