Provider Demographics
NPI:1194979773
Name:FRIENDS AND ADULT FAMILY CARE HOME
Entity type:Organization
Organization Name:FRIENDS AND ADULT FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:AGELET
Authorized Official - Middle Name:
Authorized Official - Last Name:ST-HUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-554-6051
Mailing Address - Street 1:764 AQUA SURF CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-0802
Mailing Address - Country:US
Mailing Address - Phone:904-554-6051
Mailing Address - Fax:904-361-3235
Practice Address - Street 1:764 AQUA SURF CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-0802
Practice Address - Country:US
Practice Address - Phone:904-554-6051
Practice Address - Fax:904-361-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906276311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home