Provider Demographics
NPI:1083121412
Name:FIRST COAST CAREGIVERS, LLC
Entity Type:Organization
Organization Name:FIRST COAST CAREGIVERS, LLC
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JURENOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-394-3203
Mailing Address - Street 1:3733 UNIVERSITY BLVD W STE 212
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2155
Mailing Address - Country:US
Mailing Address - Phone:904-394-3203
Mailing Address - Fax:904-485-8882
Practice Address - Street 1:3733 UNIVERSITY BLVD W STE 212
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2155
Practice Address - Country:US
Practice Address - Phone:904-394-3203
Practice Address - Fax:904-485-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994392251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health