Provider Demographics
NPI:1659540763
Name:TIDAJAY CARE SERVICES INC
Entity Type:Organization
Organization Name:TIDAJAY CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MUSU
Authorized Official - Middle Name:KAISAMBA
Authorized Official - Last Name:JUSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-714-1020
Mailing Address - Street 1:1140 SUNRAY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8038
Mailing Address - Country:US
Mailing Address - Phone:904-714-1020
Mailing Address - Fax:904-714-4501
Practice Address - Street 1:1140 SUNRAY CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8038
Practice Address - Country:US
Practice Address - Phone:904-714-1020
Practice Address - Fax:904-714-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5159858164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty