Agnes Street Home For The Elderly
Assisted Living Facility in Jacksonville, FL. Organization (NPI-2).
NPI number1275970204
StatusActive
Last updated in NPPESMay 31, 2013
Details
- NPI
- 1275970204
- Entity type
- Organization (NPI-2)
- Legal business name
- Agnes Street Home For The Elderly
- Organization subpart
- No
- Enumeration date
- May 31, 2013
- Last updated
- May 31, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 310400000X | Assisted Living Facility | AL5745 | FL | Yes |
Practice location
1346 Agnes StJacksonville, FL 32208-3302
Phone 904-766-7651 · Fax 904-766-7668
Mailing address
1346 Agnes StJacksonville, FL 32208-3302
Phone 904-766-7651 · Fax 904-766-7668
Authorized official
Atakelte Admasu
Owner/Administrator
9047667651
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