Healthcare Provider Details

I. General information

NPI: 1861104135
Provider Name (Legal Business Name): SERVE WELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8335 FREEDOM CROSSING TRL APT 4301
JACKSONVILLE FL
32256-8254
US

IV. Provider business mailing address

PO BOX 23251
JACKSONVILLE FL
32241-3251
US

V. Phone/Fax

Practice location:
  • Phone: 904-855-6408
  • Fax:
Mailing address:
  • Phone: 904-855-6408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KARREECHA NEWBY
Title or Position: OWNER
Credential:
Phone: 904-855-6408