Provider Demographics
NPI:1821411703
Name:ABOVE THE REST
Entity Type:Organization
Organization Name:ABOVE THE REST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:THERRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-622-7038
Mailing Address - Street 1:9030 NE JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:FL
Mailing Address - Zip Code:32617-3502
Mailing Address - Country:US
Mailing Address - Phone:352-622-7038
Mailing Address - Fax:352-236-7039
Practice Address - Street 1:9030 NE JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:FL
Practice Address - Zip Code:32617-3502
Practice Address - Country:US
Practice Address - Phone:352-622-7038
Practice Address - Fax:352-236-7039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230440251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000797800OtherMEDICAID WAIVER