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General NPI Number Information
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NPI Number | 1356143846
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Entity Type | Organization
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Legal Business Name | REFUAT HANEFESH CARE, INC.
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 3733 UNIVERSITY BLVD W STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2152
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Country | US
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Telephone | 904-755-6623
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Fax | 888-402-9512
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Provider Business Mailing Address
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Address Line | 15770 STEDMAN LAKE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32218-0619
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Country | US
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Telephone | 904-832-1623
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Fax | 888-402-9512
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Authorized Official
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Title or Position | CEO
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Name | MR. KELVIN SAMUEL II
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Credential |
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Telephone | 904-832-1623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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