| NPI | 1154762284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY WALLACE CEO 904-723-6049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| 251B00000X Case Management | |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2016-07-29 |