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General NPI Number Information
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NPI Number | 1104822923
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Entity Type | Organization
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Legal Business Name | KEEPSAFE CENTER, INC.
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5626 SOUTEL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32219-3772
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Country | US
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Telephone | 904-768-6456
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Fax | 904-765-0264
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Provider Business Mailing Address
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Address Line | 5626 SOUTEL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32219-3772
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Country | US
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Telephone | 904-768-6456
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Fax | 904-765-0264
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. HERMONYONE W WALKER
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Credential | MS
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Telephone | 904-768-6456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | N11795
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License Number State | FL
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