Healthcare Provider Details

I. General information

NPI: 1730650573
Provider Name (Legal Business Name): TURNAROUND RETREAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 E 13TH ST
JACKSONVILLE FL
32206-3105
US

IV. Provider business mailing address

1159 E 13TH ST
JACKSONVILLE FL
32206-3105
US

V. Phone/Fax

Practice location:
  • Phone: 904-660-8835
  • Fax:
Mailing address:
  • Phone: 904-660-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
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
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TONEESHA SINGLETON
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-305-8828