Provider Demographics
NPI:1992947170
Name:PATRICIA JONES ADULT FAMILY CARE HOME
Entity type:Organization
Organization Name:PATRICIA JONES ADULT FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CNA/BS
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:321-676-1714
Mailing Address - Street 1:207 OLIVICK CIR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1136
Mailing Address - Country:US
Mailing Address - Phone:321-676-1714
Mailing Address - Fax:321-676-1714
Practice Address - Street 1:207 OLIVICK CIR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1136
Practice Address - Country:US
Practice Address - Phone:321-676-1714
Practice Address - Fax:321-676-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906308311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52962609OtherAGENCY FOR HEALTH CARE ADMINISTRATION
FL6906308OtherAGENCY FOR HEALTH CARE ADMINISTRATION