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General NPI Number Information
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NPI Number | 1790202711
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Entity Type | Organization
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Legal Business Name | PEMBERLEY ADMINISTRATIVE SERVICES, LLC
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 08/30/2017
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Provider Practice Location Address
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Address Line | 157 HAMPTON POINT DR STE 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3054
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Country | US
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Telephone | 904-466-1106
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Fax |
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Provider Business Mailing Address
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Address Line | 1175 WESTWOOD DR
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City | SAINT JOHNS
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State | FL
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Zip | 32259-9293
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Country | US
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Telephone | 904-466-1106
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA BRITT
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Credential |
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Telephone | 904-466-1106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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