MARINA CAMPOS
Adult Care Home
Jacksonville, Florida
Provider NPI: 1669631214
Provider Information:MARINA CAMPOS
Practice Location:
2264 DELLWOOD AVE JACKSONVILLE, FL 32204 US
Tel: 904-384-3888 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | FL | 6905793 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
142300200 | FL | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin