| NPI | 1962189027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DE'ARIS WILLIAM HENRY Medicaid 904-834-1113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2023-06-30 |