Basic Information
| Provider Information | |||||||||
| NPI: | 1508520792 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLETCHER'S TENDER CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 19TH AVENUE NORTH | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047593203 | ||||||||
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| Practice Location | |||||||||
| Address1: | 641 WEST 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048589797 | ||||||||
| FaxNumber: | 9048581792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2021 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | FLETCHER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9047593203 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3140N1450X | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric | 261QM3000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medically Fragile Intants and Children Day Care |
No ID Information.