Healthcare Provider Details

I. General information

NPI: 1629731492
Provider Name (Legal Business Name): COSTON CARES AND CONSULTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5734 BRAIT AVE
JACKSONVILLE FL
32209-2252
US

IV. Provider business mailing address

5734 BRAIT AVE
JACKSONVILLE FL
32209-2252
US

V. Phone/Fax

Practice location:
  • Phone: 904-735-8319
  • Fax:
Mailing address:
  • Phone: 904-735-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHEMECH PATTERSON
Title or Position: OWNER
Credential: BCBA
Phone: 904-735-8319