| NPI | 1104205152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNADETTE EVELYENNA FIELDS Executive Director 904-483-1870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 251S00000X |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2016-09-08 |