Provider Demographics
NPI:1841797354
Name:OBI'S ADULT FAMILY CARE LLC
Entity Type:Organization
Organization Name:OBI'S ADULT FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-728-7474
Mailing Address - Street 1:3130 KINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-2524
Mailing Address - Country:US
Mailing Address - Phone:904-728-7474
Mailing Address - Fax:
Practice Address - Street 1:3130 KINGSTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-2524
Practice Address - Country:US
Practice Address - Phone:904-728-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OBI'S ADULT FAMILY CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906906311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6906906Medicaid