Healthcare Provider Details

I. General information

NPI: 1659520047
Provider Name (Legal Business Name): JOHN CALVIN HALE CASE MANAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 BEECHWOOD ST 623 BEECHWOOD ST
JACKSONVILLE FL
32206-6236
US

IV. Provider business mailing address

623 BEECHWOOD ST 623 BEECHWOOD ST
JACKSONVILLE FL
32206-6236
US

V. Phone/Fax

Practice location:
  • Phone: 904-358-1211
  • Fax: 904-358-1551
Mailing address:
  • Phone: 904-358-1211
  • Fax: 904-358-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: