Organization
KPNCINC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AGELET ST HUBERT (OWNER/PRESIDENT)
(904) 554-6051
Entity
Organization
Contact information
Practice address
764 AQUA SURF CT, JACKSONVILLE, FL 32225-0802
(904) 554-6051
(904) 361-3235
Mailing address
764 AQUA SURF CT, JACKSONVILLE, FL 32225-0802
(904) 554-6051
(904) 361-3235
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
6906603
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000568100
—
FL
Enumeration date
05/21/2013
Last updated
05/21/2013
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