Provider Demographics
NPI: | 1063844348 |
---|---|
Name: | BISHOP HOME CARE,INC |
Entity Type: | Organization |
Organization Name: | BISHOP HOME CARE,INC |
Other - Org Name: | AUTUMN OAKS VILLA |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | MARY |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | MCGEE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 904-571-9211 |
Mailing Address - Street 1: | 1627 E 8TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | JACKSONVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32206-5407 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 904-355-9731 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1823 UNIVERSITY BLVD S |
Practice Address - Street 2: | |
Practice Address - City: | JACKSONVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32216-8930 |
Practice Address - Country: | US |
Practice Address - Phone: | 904-405-0040 |
Practice Address - Fax: | 904-355-9731 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-08-08 |
Last Update Date: | 2013-08-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |