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General NPI Number Information
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NPI Number | 1134014384
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Entity Type | Organization
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Legal Business Name | HAVENRISE ACADEMY OF JACKSONVILLE, LLC
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 10550 DEERWOOD PARK BLVD STE 301
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2805
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Country | US
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Telephone | 904-352-0682
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Fax |
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Provider Business Mailing Address
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Address Line | 10550 DEERWOOD PARK BLVD STE 301
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2805
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Country | US
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Telephone | 904-352-0682
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JAMIE STEVENS
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Credential |
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Telephone | 904-993-1559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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