Healthcare Provider Details

I. General information

NPI: 1003739657
Provider Name (Legal Business Name): INNER CITY CHRISTIAN CENTER OF JACKSONVILLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W 8TH ST
JACKSONVILLE FL
32206-4331
US

IV. Provider business mailing address

320 W 8TH ST
JACKSONVILLE FL
32206-4331
US

V. Phone/Fax

Practice location:
  • Phone: 904-312-7995
  • Fax:
Mailing address:
  • Phone: 904-312-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVA HAMPTON
Title or Position: HEAD OF SCHOOL
Credential:
Phone: 904-312-7995