Provider Demographics
NPI:1164253100
Name:ATLANTIC CARE HOME HEALTH JACKSONVILLE LLC
Entity type:Organization
Organization Name:ATLANTIC CARE HOME HEALTH JACKSONVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:COONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-484-2972
Mailing Address - Street 1:163 E MORSE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7415
Mailing Address - Country:US
Mailing Address - Phone:407-270-5501
Mailing Address - Fax:
Practice Address - Street 1:728 FENTRESS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1214
Practice Address - Country:US
Practice Address - Phone:407-270-5501
Practice Address - Fax:407-559-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty