1710363965 NPI number — FIFTH COMMANDMENT HOME HEALTHCARE

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 1710363965 NPI number — FIFTH COMMANDMENT HOME HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIFTH COMMANDMENT HOME HEALTHCARE
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:
1710363965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1279 KINGSLEY AVE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-4603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-592-7736
Provider Business Mailing Address Fax Number:
904-602-5328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1279 KINGSLEY AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-592-7736
Provider Business Practice Location Address Fax Number:
904-602-5328
Provider Enumeration Date:
08/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ENGELKES
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/CEO/ADMINISTRATOR
Authorized Official Telephone Number:
904-592-7736

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)





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