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General NPI Number Information
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NPI Number | 1023279478
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Entity Type | Organization
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Legal Business Name | ST JOHN SUPPORT SERVICES, INC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 435 CLARK RD STE 408-3
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8505
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Country | US
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Telephone | 904-768-6116
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Fax | 904-713-0307
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Provider Business Mailing Address
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Address Line | 435 CLARK RD STE 408-3
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8505
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Country | US
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Telephone | 904-768-6116
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Fax | 904-713-0307
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Authorized Official
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Title or Position | OWNER
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Name | THERESA A ISHMAN-HOLT
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Credential |
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Telephone | 904-768-6116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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