Provider Demographics
NPI:1114744976
Name:JEREMIAH'S WALK HOME & HEALTH AGENCY, LLC
Entity type:Organization
Organization Name:JEREMIAH'S WALK HOME & HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-400-9864
Mailing Address - Street 1:3757 LONGLEAF FOREST LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-9100
Mailing Address - Country:US
Mailing Address - Phone:904-413-8839
Mailing Address - Fax:
Practice Address - Street 1:3757 LONGLEAF FOREST LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9100
Practice Address - Country:US
Practice Address - Phone:904-413-8839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care