Healthcare Provider Details

I. General information

NPI: 1952484438
Provider Name (Legal Business Name): GREENFIELD CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 LAKESIDE DR STE 213
JACKSONVILLE FL
32210-3369
US

IV. Provider business mailing address

5001 SPRING VALLEY RD STE 600E
DALLAS TX
75244-8217
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-3784
  • Fax: 904-389-4618
Mailing address:
  • Phone: 214-365-6100
  • Fax: 214-365-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. JAY HIGHAM
Title or Position: CEO
Credential:
Phone: 214-365-6100