| NPI | 1063045094 |
|---|---|
| Doing Business As | ODOMS TLC HOMECARE SERVICE |
| Entity Type | Organization |
| Authorized Contact | LOLITA BURNNETT ELLIS Medicaid Provider 904-362-2487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-02-18 |