Healthcare Provider Details

I. General information

NPI: 1891702932
Provider Name (Legal Business Name): BOYS' HOME ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2354 UNIVERSITY BLVD N
JACKSONVILLE FL
32211-3228
US

IV. Provider business mailing address

2354 UNIVERSITY BLVD N
JACKSONVILLE FL
32211-3228
US

V. Phone/Fax

Practice location:
  • Phone: 904-743-3611
  • Fax: 904-744-8131
Mailing address:
  • Phone: 904-743-3611
  • Fax: 904-744-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT BROWN JR.
Title or Position: PRESIDENT
Credential:
Phone: 904-743-3611