Healthcare Provider Details

I. General information

NPI: 1215735808
Provider Name (Legal Business Name): COMMUNITY HEALTH INITIATIVES GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 ARLINGTON RD N
JACKSONVILLE FL
32211-5956
US

IV. Provider business mailing address

8411 SOUTHSIDE BLVD STE 100
JACKSONVILLE FL
32256-0755
US

V. Phone/Fax

Practice location:
  • Phone: 904-323-4488
  • Fax: 904-323-4488
Mailing address:
  • Phone: 904-323-4488
  • Fax: 904-323-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON MOUNT
Title or Position: PRESIDENT
Credential:
Phone: 904-699-2332