Individual
ANGELA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
720 VALLEY FORGE RD, JACKSONVILLE, FL 32208-3566
(904) 405-9681
Mailing address
720 VALLEY FORGE RD, JACKSONVILLE, FL 32208-3566
(904) 405-9681
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906432
FL
Other
Enumeration date
05/05/2014
Last updated
05/05/2014
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