Provider Demographics
NPI:1164151726
Name:AGING GRACE ENTERPRISES LLC
Entity Type:Organization
Organization Name:AGING GRACE ENTERPRISES LLC
Other - Org Name:CARING SENIOR SERVICE OF SOUTH DUVAL COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-313-6460
Mailing Address - Street 1:858 NW SAVANNAH CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-6878
Mailing Address - Country:US
Mailing Address - Phone:813-313-6460
Mailing Address - Fax:
Practice Address - Street 1:9850 SAN JOSE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5495
Practice Address - Country:US
Practice Address - Phone:813-313-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care