Provider Demographics
NPI:1568514826
Name:JCI FAMILY CORPORATION
Entity Type:Organization
Organization Name:JCI FAMILY CORPORATION
Other - Org Name:HOMEWELL SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CARE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-298-9612
Mailing Address - Street 1:PO BOX 5334
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32728-5334
Mailing Address - Country:US
Mailing Address - Phone:407-298-9612
Mailing Address - Fax:386-259-4065
Practice Address - Street 1:1560 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8439
Practice Address - Country:US
Practice Address - Phone:407-298-9612
Practice Address - Fax:386-259-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBU0006403251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health