PRODIGAL S D CORPORATION NPI 1184153934

NPI Information

PRODIGAL S D CORPORATION is an addiction (substance use disorder) counselor in Jacksonville, FL. PRODIGAL S D CORPORATION NPI is 1184153934. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Prodigal Kids.

The provider's business location address is:

9521 SHELLIE RD STE 13
JACKSONVILLE, FL
ZIP 32257-174
Phone: (904) 930-4244
Fax: (954) 256-8140

The provider's authorized official is Freda Stevens .
The authorized official title is Executive Director and has the following contact phone number (904) 930-4244.

The enumeration date for this NPI number is 6/6/2017 and was last updated on 6/6/2017.

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:

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