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General NPI Number Information
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NPI Number | 1922455153
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Entity Type | Organization
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Legal Business Name | C & D ENTERPRISES OF NE FL, LLC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 8058 SWAMP FLOWER DR E
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6161
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Country | US
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Telephone | 904-955-9779
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8303
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City | JACKSONVILLE
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State | FL
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Zip | 32239-0303
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Country | US
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Telephone | 904-955-9779
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | CHRISTIANE GOODEN
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Credential |
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Telephone | 904-608-1861
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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 |
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License Number State |
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