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General NPI Number Information
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NPI Number | 1568507853
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Entity Type | Organization
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Legal Business Name | RIVER REGION HUMAN SERVICES INC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 3901 CARMICHAEL AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2325
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Country | US
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Telephone | 904-899-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 CARMICHAEL AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2325
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Country | US
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Telephone | 904-899-6300
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Fax |
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Authorized Official
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Title or Position | CLINICAL CONSULTANT
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Name | JOHN DISTEFANO
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Credential |
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Telephone | 352-317-3214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | FL
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