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General NPI Number Information
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NPI Number | 1396369187
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Entity Type | Organization
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Legal Business Name | IM SULZBACHER CENTER FOR THE HOMELESS, INC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 5455 SPRINGFIELD BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32208-5166
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Country | US
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Telephone | 904-394-4958
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Fax |
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Provider Business Mailing Address
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Address Line | 611 E ADAMS ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-2847
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Country | US
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Telephone | 904-394-5481
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CINDY FUNKHOUSER
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Credential |
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Telephone | 904-394-4958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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