Healthcare Provider Details

I. General information

NPI: 1346757259
Provider Name (Legal Business Name): BROWN'S TRANSITIONAL SUPPORTED LIVING OF FL,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5831 LISKA DR
JACKSONVILLE FL
32244-2183
US

IV. Provider business mailing address

5831 LISKA DR
JACKSONVILLE FL
32244-2183
US

V. Phone/Fax

Practice location:
  • Phone: 904-651-6049
  • Fax:
Mailing address:
  • Phone: 904-651-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE SMITH-BROWN
Title or Position: OWNER/OPERATOR
Credential:
Phone: 904-651-6049