Provider Demographics
NPI:1528491362
Name:HAYLEY JUMPP AFCH
Entity type:Organization
Organization Name:HAYLEY JUMPP AFCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUMPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-967-8428
Mailing Address - Street 1:5224 MADISON STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-967-8428
Mailing Address - Fax:954-589-5230
Practice Address - Street 1:5224 MADISON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7130
Practice Address - Country:US
Practice Address - Phone:954-967-8428
Practice Address - Fax:954-589-5230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906593311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN