1184895740 NPI number — BROOKS HOME CARE ADVANTAGE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184895740 NPI number — BROOKS HOME CARE ADVANTAGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKS HOME CARE ADVANTAGE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184895740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3599 UNIVERSITY BLVD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-4252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-345-7291
Provider Business Mailing Address Fax Number:
904-345-7284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6676 CORPORATE CENTER PKWY STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-8091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-722-1515
Provider Business Practice Location Address Fax Number:
904-722-1517
Provider Enumeration Date:
03/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
JENI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF MANAGED CARE
Authorized Official Telephone Number:
904-345-7158

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 299993790 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 299991968 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 299993789 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 299991243 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".