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General NPI Number Information
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NPI Number | 1518468446
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Entity Type | Organization
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Legal Business Name | JENESYS HEARTS, LLC
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 02/26/2018
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Provider Practice Location Address
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Address Line | 8597 FALLING SPRINGS DR
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City | JACKSONVILLE
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State | FL
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Zip | 32244-8461
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Country | US
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Telephone | 904-866-6961
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440605
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City | JACKSONVILLE
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State | FL
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Zip | 32222-0007
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Country | US
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Telephone | 904-866-6961
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANCHETTA SUTTON
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Credential | EDS, LCSW
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Telephone | 904-866-6961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW14369
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License Number State | FL
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