Provider Demographics
NPI:1508917071
Name:BETTER CARE OF JAX
Entity Type:Organization
Organization Name:BETTER CARE OF JAX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAQUITA
Authorized Official - Middle Name:SHANELLE
Authorized Official - Last Name:BUCKHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-472-0066
Mailing Address - Street 1:2658 SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2570
Mailing Address - Country:US
Mailing Address - Phone:904-472-0066
Mailing Address - Fax:
Practice Address - Street 1:2658 SANDRA LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-2570
Practice Address - Country:US
Practice Address - Phone:904-472-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
FL691047596385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691047503Medicaid
FL691047596Medicaid
FL691047598Medicaid