Provider Demographics
NPI:1225718331
Name:MACKSVILLE SOLUTIONS LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:MACKSVILLE SOLUTIONS LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAVIST
Authorized Official - Middle Name:S
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-609-1185
Mailing Address - Street 1:7707 MERRILL RD UNIT 11642
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-7767
Mailing Address - Country:US
Mailing Address - Phone:904-609-1185
Mailing Address - Fax:
Practice Address - Street 1:3917 BROOKDALE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-1317
Practice Address - Country:US
Practice Address - Phone:904-609-1185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility