MEDICARE: FAMILY SUPPORT SERVICES OF NORTH FLORIDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1174552046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY SUPPORT SERVICES OF NORTH FLORIDA

Provider Business Mailing Address
First Line	:	4057 CARMICHAEL AVE
Second Line	:	BUILDING 3000, SUITE 101
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2336
Country	:	US
Telephone Number	:	904-421-5800
Fax Number	:	904-421-5801

Provider Business Practice Location Address
First Line	:	4057 CARMICHAEL AVE
Second Line	:	BUILDING 3000, SUITE 101
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2336
Country	:	US
Telephone Number	:	904-421-5800
Fax Number	:	904-421-5801

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. LEE E WILSON
Credential	:	CPA
Telephone Number	:	904-421-5816

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	08/22/2020

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