Provider Demographics
NPI:1154749141
Name:JAX INTEGRITY PARTNERS, INC.
Entity type:Organization
Organization Name:JAX INTEGRITY PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:904-302-7560
Mailing Address - Street 1:144 ARLINGTON RD S
Mailing Address - Street 2:SUITE #1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-7203
Mailing Address - Country:US
Mailing Address - Phone:904-302-7560
Mailing Address - Fax:904-352-2357
Practice Address - Street 1:144 ARLINGTON RD S
Practice Address - Street 2:SUITE #1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-7203
Practice Address - Country:US
Practice Address - Phone:904-302-7560
Practice Address - Fax:904-352-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299994100OtherAHCA HOME HEALTH AGENCY LICENSE
FL232729OtherAHCA HOMEMAKER & COMPANION SERVICES LICENSE