Provider Demographics
NPI:1457119356
Name:SHAWN DAVIS HEALTHCARE LLC
Entity Type:Organization
Organization Name:SHAWN DAVIS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANTIAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-386-2771
Mailing Address - Street 1:7643 GATE PKWY STE 104-9222
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3092
Mailing Address - Country:US
Mailing Address - Phone:904-386-2771
Mailing Address - Fax:904-339-5403
Practice Address - Street 1:7643 GATE PKWY STE 104-9222
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3092
Practice Address - Country:US
Practice Address - Phone:904-386-2771
Practice Address - Fax:904-339-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care