Organization
GLY COMMUNITY SUPPORT SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAKESHA TYJUAN HOLMES (AUTHORIZED OFFICIAL)
(904) 758-6333
Entity
Organization
Contact information
Practice address
1646 PORTER LAKES DR, JACKSONVILLE, FL 32218-8321
(904) 758-6333
Mailing address
1646 PORTER LAKES DR, JACKSONVILLE, FL 32218-8321
(904) 758-6333
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
344600000X
Taxi
—
—
347B00000X
Bus
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
05/07/2025
Last updated
05/07/2025
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