Provider Demographics
NPI:1316369044
Name:SIGNATURE STAFF SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SIGNATURE STAFF SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOMAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-679-1819
Mailing Address - Street 1:138 PALM COAST PKWY NE # 258
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8241
Mailing Address - Country:US
Mailing Address - Phone:904-679-1819
Mailing Address - Fax:904-647-8096
Practice Address - Street 1:3830 CROWN POINT RD STE F
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-7553
Practice Address - Country:US
Practice Address - Phone:904-679-1819
Practice Address - Fax:904-647-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1585163W00000X, 163WI0500X, 164W00000X, 171M00000X, 3747P1801X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1585OtherAHCA HEALTH CARE SERVICES POOL