Organization
HAGAN ASSISTED LIVING FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON MCINTYRE (PRESIDENT)
(904) 382-3655
Entity
Organization
Contact information
Practice address
3104 W 12TH ST, JACKSONVILLE, FL 32254-1808
(904) 382-3655
Mailing address
3104 W 12TH ST, JACKSONVILLE, FL 32254-1808
(904) 382-3655
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL10746
FL
385H00000X
Respite Care
AL10746
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11100
—
FL
Enumeration date
12/08/2008
Last updated
12/08/2008
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