1407175789 NPI number — ABSOLUTE CARE HOME HEALTH SERVICES

Table of content: (NPI 1407175789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407175789 NPI number — ABSOLUTE CARE HOME HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTE CARE HOME HEALTH SERVICES
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:
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:
1407175789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1839 LANE AVE S STE 106
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:
32210-1260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-379-1337
Provider Business Mailing Address Fax Number:
904-738-8721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4613 PHILLIPS HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 208-A
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-7290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-379-1337
Provider Business Practice Location Address Fax Number:
904-738-8721
Provider Enumeration Date:
05/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LABIAL
Authorized Official First Name:
GUILLERMO
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
904-379-1337

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 299993731 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 022885800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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