Healthcare Provider Details

I. General information

NPI: 1356143846
Provider Name (Legal Business Name): REFUAT HANEFESH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 UNIVERSITY BLVD W STE 202
JACKSONVILLE FL
32217-2152
US

IV. Provider business mailing address

15770 STEDMAN LAKE DR
JACKSONVILLE FL
32218-0619
US

V. Phone/Fax

Practice location:
  • Phone: 904-755-6623
  • Fax: 888-402-9512
Mailing address:
  • Phone: 904-832-1623
  • Fax: 888-402-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. KELVIN SAMUEL II
Title or Position: CEO
Credential:
Phone: 904-832-1623