| NPI | 1215345160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEYSEL ACOSTA Administrator, CEO 904-504-0504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 251E00000X Home Health (Licence: FL 299994677) |
| 261Q00000X Clinic/Center | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2025-08-08 |