Healthcare Provider Details

I. General information

NPI: 1336602093
Provider Name (Legal Business Name): SPECIAL METHODS IN LIFE ENRICHMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7187 OVERLAND PARK BLVD E
JACKSONVILLE FL
32244-4254
US

IV. Provider business mailing address

7187 OVERLAND PARK BLVD E
JACKSONVILLE FL
32244-4254
US

V. Phone/Fax

Practice location:
  • Phone: 904-418-1440
  • Fax:
Mailing address:
  • Phone: 904-418-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHAKYNA R HATHORN
Title or Position: OWNER
Credential:
Phone: 904-418-1440