Peacock Companion & Caregiving Serivce

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PEACOCK COMPANION & CAREGIVING SERIVCE

Practice address

2918 Willow St
Jacksonville, FL 32207-4458

Phone

(904) 882-5777

NPI assigned

Jun 24, 2024

Last updated

Jul 20, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

La'Roniquia Bre'Nae Fleming

Title

Owner

Phone

(904) 254-0469

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721433600000",
    "number": "1417791500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2918 WILLOW ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322074458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2918 WILLOW ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322074458",
            "telephone_number": "904-882-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK COMPANION & CAREGIVING SERIVCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-07-20",
        "certification_date": "2024-07-20",
        "status": "A",
        "authorized_official_last_name": "FLEMING",
        "authorized_official_first_name": "LA'RONIQUIA",
        "authorized_official_middle_name": "BRE'NAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-254-0469"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.