Healthcare Provider Details

I. General information

NPI: 1871783001
Provider Name (Legal Business Name): KIROS NEW HORIZONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 WHITLY CT
JACKSONVILLE FL
32246-2484
US

IV. Provider business mailing address

12739 SERENADE CIR N
JACKSONVILLE FL
32225-3958
US

V. Phone/Fax

Practice location:
  • Phone: 904-312-2965
  • Fax:
Mailing address:
  • Phone: 904-312-2965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. CYCLYN R SMITH-MOBLEY
Title or Position: PRESIDENT/ CEO
Credential:
Phone: 904-327-5559