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General NPI Number Information
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NPI Number | 1215350178
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Entity Type | Organization
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Legal Business Name | NEVAEH II (MH-TCM) PERSONAL DEVELOPMENT & SUPPORTS IC.
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 5150 TIMUQUANA RD STE 14
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8925
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Country | US
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Telephone | 904-386-3901
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Fax |
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Provider Business Mailing Address
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Address Line | 5150 TIMUQUANA RD STE 14
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8925
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Country | US
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Telephone | 904-386-3901
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA MITCHELL
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Credential |
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Telephone | 904-386-3901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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