Provider Demographics
NPI:1457661910
Name:PRINCENIA A HICKS HOMEMAKER COMPANION SERVICE
Entity Type:Organization
Organization Name:PRINCENIA A HICKS HOMEMAKER COMPANION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRINCENIA
Authorized Official - Middle Name:HICKS
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-638-9710
Mailing Address - Street 1:6028 CHESTER AVE
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-1205
Mailing Address - Country:US
Mailing Address - Phone:904-638-9710
Mailing Address - Fax:904-212-0197
Practice Address - Street 1:6028 CHESTER AVE
Practice Address - Street 2:SUITE # 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-1205
Practice Address - Country:US
Practice Address - Phone:904-638-9710
Practice Address - Fax:904-212-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health