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General NPI Number Information
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NPI Number | 1184308108
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Entity Type | Organization
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Legal Business Name | CRAFT BEHAVIORAL HEALTH CLINIC
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 10175 FORTUNE PKWY UNIT 1106
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6757
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Country | US
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Telephone | 904-337-0768
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Fax | 904-379-5967
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Provider Business Mailing Address
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Address Line | 10175 FORTUNE PKWY UNIT 1106
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6757
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Country | US
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Telephone | 904-337-0768
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Fax | 904-379-5967
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. MOHAMMED FAROOQUE
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Credential | MD, PHD
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Telephone | 904-379-5928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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