CCN: 683109 NPI: 1457609984 Organization

FAMILY CARE SUPPORT PROGRAM

11401 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 322581402

Contact Information

Phone 9048868409
Fax 9048802968
Enumeration Date 2012-08-15
Last Updated 2026-01-26

Taxonomies

Code: 251E00000X (Primary) License State: FL License: HHA299991334

Inpatient Payment Attributes (IPSF) View Dictionary →

Effective Date:

censusDivision 3

cbsaActualGeographicLocation 27260

providerType 36

censusDivision 3

cbsaActualGeographicLocation 27260

providerType 36

censusDivision 3

cbsaActualGeographicLocation 27260

providerType 36

censusDivision 3

cbsaActualGeographicLocation 27260

providerType 36

censusDivision 3

cbsaActualGeographicLocation 27260

providerType 36

censusDivision 3

cbsaActualGeographicLocation 27260

providerType 36

censusDivision 3

cbsaActualGeographicLocation 27260

providerType 36

Outpatient Payment Attributes (OPSF) View Dictionary →

Effective Date:

cbsaActualGeographicLocation 27260

providerType 36

specialPaymentIndicator

carrierCode 09102

localityCode 99