Healthcare Provider Details

I. General information

NPI: 1215064126
Provider Name (Legal Business Name): ST. JOHNS RIVER RURAL HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 CESERY BLVD SUITE 210
JACKSONVILLE FL
32211-7116
US

IV. Provider business mailing address

644 CESERY BLVD SUITE 210
JACKSONVILLE FL
32211-7165
US

V. Phone/Fax

Practice location:
  • Phone: 904-723-2162
  • Fax: 904-723-2170
Mailing address:
  • Phone: 904-723-2162
  • Fax: 904-723-2170

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: MS. LORI ANN BILELLO
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-723-2162