| New Heaven Dominion, Inc | |
|
9146 Ridge Brier Ln Jacksonville FL 32225-9325 | |
| (904) 647-6651 | |
| (904) 647-6653 |
| Full Name | New Heaven Dominion, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9146 Ridge Brier Ln, Jacksonville, Florida |
| Authorized Official Name and Position | Brian Arthur George (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9047900721 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New Heaven Dominion, Inc 12355 Finns Cove Trl Jacksonville FL 32246-4198 Ph: (904) 790-0721 | New Heaven Dominion, Inc 9146 Ridge Brier Ln Jacksonville FL 32225-9325 Ph: (904) 647-6651 |
| NPI Number | 1265680805 |
|---|---|
| Provider Enumeration Date | 09/08/2008 |
| Last Update Date | 09/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265680805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 02084206 (Florida) | Primary |
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