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General NPI Number Information
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NPI Number | 1790104743
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Entity Type | Organization
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Legal Business Name | J AND R SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 3119 SPRING GLEN RD STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5914
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Country | US
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Telephone | 904-534-1296
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Fax |
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Provider Business Mailing Address
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Address Line | 3119 SPRING GLEN RD STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5914
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Country | US
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Telephone | 904-534-1296
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | JAMES FREEMAN
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Credential |
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Telephone | 904-534-1296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | S266693095001
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License Number State | FL
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