Healthcare Provider Details

I. General information

NPI: 1508321498
Provider Name (Legal Business Name): TAURUS MEMORIAL FOUNDATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11513 KINGS RIDGE CT S
JACKSONVILLE FL
32218-8125
US

IV. Provider business mailing address

11513 KINGS RIDGE CT S
JACKSONVILLE FL
32218-8125
US

V. Phone/Fax

Practice location:
  • Phone: 904-489-4223
  • Fax:
Mailing address:
  • Phone: 904-489-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. MINDI GARDNER
Title or Position: OWNER
Credential: MSW, LCSW, CBHCMS
Phone: 904-489-4223