Provider Demographics
NPI:1760834394
Name:JOHNSON HOMECARE (JACKSONVILLE), LLC
Entity Type:Organization
Organization Name:JOHNSON HOMECARE (JACKSONVILLE), LLC
Other - Org Name:COMFORCARE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-232-4407
Mailing Address - Street 1:9432 BAYMEADOWS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7988
Mailing Address - Country:US
Mailing Address - Phone:904-232-4407
Mailing Address - Fax:904-642-6131
Practice Address - Street 1:9432 BAYMEADOWS RD STE 120
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7988
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:2016-07-07
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health