Healthcare Provider Details

I. General information

NPI: 1174552046
Provider Name (Legal Business Name): FAMILY SUPPORT SERVICES OF NORTH FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 CARMICHAEL AVE BUILDING 3000, SUITE 101
JACKSONVILLE FL
32207-2336
US

IV. Provider business mailing address

4057 CARMICHAEL AVE BUILDING 3000, SUITE 101
JACKSONVILLE FL
32207-2336
US

V. Phone/Fax

Practice location:
  • Phone: 904-421-5800
  • Fax: 904-421-5801
Mailing address:
  • Phone: 904-421-5800
  • Fax: 904-421-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LEE E WILSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 904-421-5816