Provider Demographics
NPI:1780667220
Name:INTERIM HEALTHCARE OF JACKSONVILLE, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF JACKSONVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-448-1133
Mailing Address - Street 1:7999 PHILIPS HWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4443
Mailing Address - Country:US
Mailing Address - Phone:904-448-1133
Mailing Address - Fax:904-448-9130
Practice Address - Street 1:2233 PARK AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5570
Practice Address - Country:US
Practice Address - Phone:904-527-2030
Practice Address - Fax:904-621-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA205710961251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health