Provider Demographics
NPI:1447239991
Name:LIL' MAMA'S TOTAL CARE SERVICE
Entity Type:Organization
Organization Name:LIL' MAMA'S TOTAL CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:AUSTIN-JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-228-7761
Mailing Address - Street 1:PO BOX 26846
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-6846
Mailing Address - Country:US
Mailing Address - Phone:904-228-7761
Mailing Address - Fax:866-612-3472
Practice Address - Street 1:3955 WINDY GALE DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4423
Practice Address - Country:US
Practice Address - Phone:904-228-7761
Practice Address - Fax:866-612-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6908918 00Medicaid