Healthcare Provider Details

I. General information

NPI: 1245641646
Provider Name (Legal Business Name): JMH DEVELOPMENT USA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 US HIGHWAY 17 SUITE 103
FLEMING ISLAND FL
32003-4832
US

IV. Provider business mailing address

4375 US HIGHWAY 17 SUITE 103
FLEMING ISLAND FL
32003-4832
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-0886
  • Fax: 904-269-0499
Mailing address:
  • Phone: 904-269-0886
  • Fax: 904-269-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5348
License Number StateFL

VIII. Authorized Official

Name: DR. JASON MATTHEW HOSCH
Title or Position: PRESIDENT
Credential: PHD, LMHC, LCCC
Phone: 904-269-0886