Healthcare Provider Details

I. General information

NPI: 1295921146
Provider Name (Legal Business Name): JACKSON COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2973 PENNSYLVANIA AVE
MARIANNA FL
32448-2713
US

IV. Provider business mailing address

2973 PENNSYLVANIA AVE
MARIANNA FL
32448-2713
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-7333
  • Fax:
Mailing address:
  • Phone: 850-526-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberF006
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberF006
License Number StateFL

VIII. Authorized Official

Name: MS. FRANCES HENDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-526-7333