Provider Demographics
NPI:1720377450
Name:VANNESS CO., LLC
Entity Type:Organization
Organization Name:VANNESS CO., LLC
Other - Org Name:COMFORCARE SENIOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:METLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-232-4407
Mailing Address - Street 1:8825 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1108
Mailing Address - Country:US
Mailing Address - Phone:904-232-4407
Mailing Address - Fax:904-642-6131
Practice Address - Street 1:8825 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1108
Practice Address - Country:US
Practice Address - Phone:904-232-4407
Practice Address - Fax:904-642-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992134253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care