MEDICARE: NORTHWEST BEHAVIORAL HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251B00000X	Case Management Agency	FL
2	251C00000X	Developmentally Disabled Services Day Training Agency	FL
3	251S00000X	Community/Behavioral Health Agency	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	284275	OTHER	FL	HMO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023016839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST BEHAVIORAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	2392 EDGEWOOD AVE N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-1725
Country	:	US
Telephone Number	:	904-781-0600
Fax Number	:	904-781-8685

Provider Business Practice Location Address
First Line	:	2392 EDGEWOOD AVE N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-1725
Country	:	US
Telephone Number	:	904-781-7797
Fax Number	:	904-781-8685

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR, CEO
Name	:	MS. TERRI D GLOVER
Credential	:	MA
Telephone Number	:	904-781-0600

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	11/07/2023

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