Healthcare Provider Details

I. General information

NPI: 1770868010
Provider Name (Legal Business Name): COMMUNITY REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 BEECHWOOD ST
JACKSONVILLE FL
32206-6236
US

IV. Provider business mailing address

623 BEECHWOOD ST
JACKSONVILLE FL
32206-6236
US

V. Phone/Fax

Practice location:
  • Phone: 904-358-1211
  • Fax: 904-358-1551
Mailing address:
  • Phone: 904-358-1211
  • Fax: 904-358-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH0000054
License Number StateFL

VIII. Authorized Official

Name: MR. WILLIAM C. JONES
Title or Position: CLINICAL THERAPIST
Credential: LMHC
Phone: 904-358-1211