Healthcare Provider Details

I. General information

NPI: 1114386778
Provider Name (Legal Business Name): ALLIED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7235 BONNEVAL RD
JACKSONVILLE FL
32256-7565
US

IV. Provider business mailing address

19925 SUTTON FALLS DR
CYPRESS TX
77433-1026
US

V. Phone/Fax

Practice location:
  • Phone: 904-309-2422
  • Fax:
Mailing address:
  • Phone: 832-490-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEVONTA J JACKSON
Title or Position: OWNER
Credential:
Phone: 832-490-8067