Provider Demographics
NPI:1730118951
Name:FLORIDA FIRST CARE D4 INC
Entity Type:Organization
Organization Name:FLORIDA FIRST CARE D4 INC
Other - Org Name:FLORIDA FIRST CARE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-233-0341
Mailing Address - Street 1:4248 LEAPING DEER LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4292
Mailing Address - Country:US
Mailing Address - Phone:904-230-0341
Mailing Address - Fax:904-230-0342
Practice Address - Street 1:2233 PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5570
Practice Address - Country:US
Practice Address - Phone:904-269-6868
Practice Address - Fax:904-269-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107725Medicare ID - Type UnspecifiedHOME HEALTH AGENCY