Provider Demographics
NPI:1871940791
Name:RIVER CITY PROFESSIONAL SERVICES, INC.
Entity type:Organization
Organization Name:RIVER CITY PROFESSIONAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-501-5988
Mailing Address - Street 1:6100 GREENLAND RD STE 602
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-7436
Mailing Address - Country:US
Mailing Address - Phone:904-418-7900
Mailing Address - Fax:904-418-7901
Practice Address - Street 1:6100 GREENLAND RD STE 602
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7436
Practice Address - Country:US
Practice Address - Phone:904-418-7900
Practice Address - Fax:904-418-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
FL30211677253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211677OtherNURSE REGISTRY LICENSE