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Assisted Living, Mental Illness

Jacksonville, Florida

Provider NPI: 1093912404

Provider Information:

Practice Location:
Tel: 904-879-4230  Fax: --

Business Mailing Address:
Tel: --  Fax: --


PrimaryCodeCategory/DescriptionStateLicense Number
Y3104A0625XNursing & Custodial Care Facilities
Assisted Living Facility
Assisted Living, Mental Illness

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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