| NPI | 1326347675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALDINE JACKSON Medicaid Waiver Provider 904-766-1570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385HR2050X Respite Care, Respite Care Camp (Licence: FL 692298896) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care (Licence: FL 692298896) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2011-03-24 |