Provider Demographics
NPI:1649632811
Name:ARDNAS HEALTH CARE SERVICES OF JACKSONVILLE
Entity type:Organization
Organization Name:ARDNAS HEALTH CARE SERVICES OF JACKSONVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KADIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-278-5462
Mailing Address - Street 1:2105 PARK AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5557
Mailing Address - Country:US
Mailing Address - Phone:904-278-5462
Mailing Address - Fax:904-215-1462
Practice Address - Street 1:2105 PARK AVE STE 25
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5557
Practice Address - Country:US
Practice Address - Phone:904-278-5462
Practice Address - Fax:904-215-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992515251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006168600Medicaid