Provider Demographics
NPI:1568659282
Name:ARDNAS HEALTH CARE SERVICES OF JACKSONVILLE
Entity Type:Organization
Organization Name:ARDNAS HEALTH CARE SERVICES OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:904-278-5462
Mailing Address - Street 1:2105 PARK AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5583
Mailing Address - Country:US
Mailing Address - Phone:904-278-5462
Mailing Address - Fax:904-215-1462
Practice Address - Street 1:2105 PARK AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5583
Practice Address - Country:US
Practice Address - Phone:904-278-5462
Practice Address - Fax:904-215-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992515251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006168600Medicaid