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PSI SERVICES III INC. NPI 1013113554


NPI Information

NPI: 1013113554
Provider Name: PSI SERVICES III, INC.
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
3890 DUNN AVE
SUITE 1104
JACKSONVILLE, FL
ZIP 32218
Phone: (904) 723-6049
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PSI SERVICES III, INC. is a community behavioral health in Jacksonville, FL. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. PSI SERVICES III, INC. NPI is 1013113554. The provider is registered as an organization entity type.

The provider's business location address is:

3890 DUNN AVE
SUITE 1104
JACKSONVILLE, FL
ZIP 32218-428
Phone: (904) 723-6049
Fax: (904) 723-5094

The provider's authorized official is Ricky Wallace .
The authorized official title is Ceo and has the following contact phone number (904) 723-6049.

The enumeration date for this NPI number is 6/22/2007 and was last updated on 7/21/2022.


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
1251C00000XDay Training, Developmentally Disabled ServicesF001FLORIDANo
2251S00000XCommunity/Behavioral HealthFLORIDAYes

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
176505 1500MEDICAIDFLORIDA
2686933596MEDICAIDFLORIDA

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.