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1727 Blanding Blvd Suite 105 Jacksonville FL 32210-1962 | |
| (904) 981-9881 | |
| (904) 981-9883 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1727 Blanding Blvd, Jacksonville, Florida |
| Authorized Official Name and Position | Teddy Leroy Moorehouse (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9049819881 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1727 Blanding Blvd Suite 105 Jacksonville FL 32210-1962 Ph: (904) 981-9881 | 1727 Blanding Blvd Suite 105 Jacksonville FL 32210-1962 Ph: (904) 981-9881 |
| NPI Number | 1538282439 |
|---|---|
| Provider Enumeration Date | 04/08/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538282439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Florida) | Primary |
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