Provider Demographics
NPI:1265822175
Name:DEMETRICE DOWDELL
Entity Type:Organization
Organization Name:DEMETRICE DOWDELL
Other - Org Name:DEMETRICE ADULT FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEMETRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-881-8908
Mailing Address - Street 1:1959 CHEROKEE COVE TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-4927
Mailing Address - Country:US
Mailing Address - Phone:904-881-8908
Mailing Address - Fax:
Practice Address - Street 1:1959 CHEROKEE COVE TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-4927
Practice Address - Country:US
Practice Address - Phone:904-881-8908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906727311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home