1427276153 NPI number — ATKINSON'S HOME HEALTH CARE, INC.

Table of content: (NPI 1427276153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427276153 NPI number — ATKINSON'S HOME HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATKINSON'S HOME HEALTH CARE, 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:
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:
1427276153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4110 SOUTHPOINT BLVD.
Provider Second Line Business Mailing Address:
STE. 110
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-269-8050
Provider Business Mailing Address Fax Number:
904-269-7378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4110 SOUTHPOINT BLVD.
Provider Second Line Business Practice Location Address:
STE. 110
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-269-8050
Provider Business Practice Location Address Fax Number:
904-269-7378
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MUYRES
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
904-269-8050

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  201550952 , 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: 027005900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163507 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 080452596 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: R3463 . This is a "BCBS DME" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: J3M . This is a "BCBS HOME HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 027005901 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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