| Jacksonville Youth Sanctuary | |
|
4570 Saint Johns Ave Suite 3 Jacksonville FL 32210-1848 | |
| (904) 389-5231 | |
| (904) 677-8019 |
| Full Name | Jacksonville Youth Sanctuary |
|---|---|
| Speciality | Social Worker |
| Location | 4570 Saint Johns Ave, Jacksonville, Florida |
| Authorized Official Name and Position | Danielle Marie Burns (TARGETED CASE MANAGER) |
| Authorized Official Contact | 9049937955 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacksonville Youth Sanctuary 4570 Saint Johns Ave Suite 3 Jacksonville FL 32210-1848 Ph: (904) 389-5231 | Jacksonville Youth Sanctuary 4570 Saint Johns Ave Suite 3 Jacksonville FL 32210-1848 Ph: (904) 389-5231 |
| NPI Number | 1104054030 |
|---|---|
| Provider Enumeration Date | 06/30/2009 |
| Last Update Date | 07/07/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104054030 | NPI | - | NPPES |
| 360358001 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 171M00000X (Florida) | Primary |
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