Organization
PORTER'S AULT CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LASHANA MEDINA PORTER (ADMINISTRATOR)
(904) 381-8962
Entity
Organization
Contact information
Practice address
700 DAY AVE, JACKSONVILLE, FL 32205-5504
(904) 381-8962
(904) 381-8861
Mailing address
700 DAY AVE, JACKSONVILLE, FL 32205-5504
(904) 381-8962
(904) 381-8861
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
9068
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
691302496
—
FL
05
—
691302498
—
FL
05
—
692088800
—
FL
Enumeration date
06/04/2008
Last updated
06/04/2008
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