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JACKSONVILLE YOUTH SANCTUARY NPI 1104054030


NPI Information

NPI: 1104054030
Provider Name: JACKSONVILLE YOUTH SANCTUARY
Classification: Social Worker - 104100000X
Entity Type: Organization
Address:
4570 SAINT JOHNS AVE
SUITE 3
JACKSONVILLE, FL
ZIP 32210
Phone: (904) 389-5231
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JACKSONVILLE YOUTH SANCTUARY is a social worker in Jacksonville, FL. The provider is a social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. JACKSONVILLE YOUTH SANCTUARY NPI is 1104054030. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4570 SAINT JOHNS AVE
SUITE 3
JACKSONVILLE, FL
ZIP 32210-848
Phone: (904) 389-5231
Fax: (904) 677-8019

The provider's authorized official is Danielle Marie Burns .
The authorized official title is Targeted Case Manager and has the following contact phone number (904) 993-7955.

The enumeration date for this NPI number is 6/30/2009 and was last updated on 7/7/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1104100000XSocial Worker171M00000XFLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1360358001MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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