NPIMap

Organization Active NPI

My Father's House Support Services LLC

  • Developmentally Disabled Services Day Training Agency
  • Jacksonville, FL
National Provider Identifier
1932841590
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
Legal business name
MY FATHER'S HOUSE SUPPORT SERVICES LLC
Doing business as
My Father's House Support Services LLC
Practice address
1130 W 28TH St
Jacksonville, FL 32209-4012
Phone
(904) 576-5756
NPI assigned
Apr 12, 2022
Last updated
Apr 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Authorized official

Name
Jemel A PowellNPI 1205403870
Title
Owner
Phone
(904) 576-5756

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Lodging Provider 177F00000X NU
Developmentally Disabled Services Day Training Agency 251C00000X NU Primary
Community Based Hospice Care Agency 251G00000X NU
Adult Day Care Clinic/Center 261QA0600X NU
Developmental Disabilities Clinic/Center 261QD1600X NU
Respite Care 385H00000X NU
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X NU
Foster Care Agency 253J00000X NU
Local Education Agency (LEA) 251300000X NU

Addresses

Primary practice location

1130 W 28TH St
Jacksonville, FL 32209-4012

Mailing address

1130 W 28TH St
Jacksonville, FL 32209-4012
Phone (904) 576-5756

Other identifiers 1

IdentifierTypeStateIssuer
1205402870MedicaidFL

Other names 1

  • MY FATHER'S HOUSE SUPPORT SERVICES LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1932841590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 W 28TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322094012",
            "telephone_number": "904-576-5756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 W 28TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322094012",
            "telephone_number": "904-576-5756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY FATHER'S HOUSE SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "JEMEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-576-5756"
    },
    "taxonomies": [
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205402870",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MY FATHER'S HOUSE SUPPORT SERVICES LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.