Provider Demographics
NPI:1083073670
Name:ALL KIDS CARE OF ORANGE PARK, LLC
Entity Type:Organization
Organization Name:ALL KIDS CARE OF ORANGE PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-683-8666
Mailing Address - Street 1:6621 SOUTHPOINT DR N
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8021
Mailing Address - Country:US
Mailing Address - Phone:904-683-8666
Mailing Address - Fax:904-683-8666
Practice Address - Street 1:2823 BOLTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-6446
Practice Address - Country:US
Practice Address - Phone:904-683-8666
Practice Address - Fax:904-683-8672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care