Healthcare Provider Details

I. General information

NPI: 1134717945
Provider Name (Legal Business Name): CONVERSIONS HEALTHCARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11610 PLEASANT CREEK DR
JACKSONVILLE FL
32218-7564
US

IV. Provider business mailing address

PO BOX 17742
JACKSONVILLE FL
32245-7742
US

V. Phone/Fax

Practice location:
  • Phone: 904-480-6403
  • Fax:
Mailing address:
  • Phone: 904-480-6403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LETA WASHINGTON
Title or Position: CEO/OWNER
Credential:
Phone: 904-480-6403