Provider Demographics
NPI:1982460747
Name:NORTHEAST FLORIDA RESIDENTIAL CARE FACILITY INC
Entity Type:Organization
Organization Name:NORTHEAST FLORIDA RESIDENTIAL CARE FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAUNDRIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SHAHEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-532-5186
Mailing Address - Street 1:4232 ARBOR MILL CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-3204
Mailing Address - Country:US
Mailing Address - Phone:904-532-5186
Mailing Address - Fax:
Practice Address - Street 1:4232 ARBOR MILL CIR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-3204
Practice Address - Country:US
Practice Address - Phone:904-532-5186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251G00000XAgenciesHospice Care, Community Based
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child