Organization
ABOVE THE REST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE M THERRIEN (OWNER)
(352) 622-7038
Entity
Organization
Contact information
Practice address
9030 NE JACKSONVILLE RD, ANTHONY, FL 32617-3502
(352) 622-7038
(352) 236-7039
Mailing address
9030 NE JACKSONVILLE RD, ANTHONY, FL 32617-3502
(352) 622-7038
(352) 236-7039
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
230440
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000797800
MEDICAID WAIVER
FL
Enumeration date
01/28/2014
Last updated
01/28/2014
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