Provider Demographics
NPI:1912202136
Name:BISHOP HOME CARE, INC
Entity Type:Organization
Organization Name:BISHOP HOME CARE, INC
Other - Org Name:BISHOP CHRISTIAN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-355-9731
Mailing Address - Street 1:1627 E 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206
Mailing Address - Country:US
Mailing Address - Phone:904-355-9731
Mailing Address - Fax:904-355-0787
Practice Address - Street 1:1627 E 8TH STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206
Practice Address - Country:US
Practice Address - Phone:904-355-9731
Practice Address - Fax:904-355-0787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BISHOP HOME CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-19
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9137261QA0600X
FL3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002279200Medicaid