MEDICARE: RIGHT TIME, RIGHT PLACE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)

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

General Provider Information

NPI Number	:	1063834729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIGHT TIME, RIGHT PLACE LLC

Provider Business Mailing Address
First Line	:	6140 CLEVELAND RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-1904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6140 CLEVELAND RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-1904
Country	:	US
Telephone Number	:	904-405-5767
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KENSLY TERRELL JOHNSON SR.
Credential	:
Telephone Number	:	904-766-7885

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	01/16/2014

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Directions to “RIGHT TIME, RIGHT PLACE LLC ” Practice Location

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