Organization
EARTHLY STARS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY MOSLEY (OWNER/ADMINISTRATOR)
(904) 472-5355
Entity
Organization
Contact information
Practice address
9616 WATERSHED DR E, JACKSONVILLE, FL 32220-0905
(904) 472-5355
Mailing address
9616 WATERSHED DR E, JACKSONVILLE, FL 32220-0905
(904) 472-5355
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
09/24/2018
Last updated
10/16/2019
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