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NPI Code Detail

MEDICARE: DANIEL MEMORIAL, INC.

MEDICARE: DANIEL MEMORIAL, INC.
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
1251B00000XCase Management Agency
2322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility
3323P00000XPsychiatric Residential Treatment Facility
4251S00000XCommunity/Behavioral Health Agency

Other Identifiers

General Provider Information

NPI Number : 1346205861
Entity Type Code : Organization
Provider Name (Legal Business Name) : DANIEL MEMORIAL, INC.
Provider Business Mailing Address
First Line : 4203 SOUTHPOINT BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-6164
Country : US
Telephone Number : 904-296-1055
Fax Number : 904-296-1953
Provider Business Practice Location Address
First Line : 3725 BELFORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-5813
Country : US
Telephone Number : 904-296-1055
Fax Number : 904-448-7700
Authorized Official
Title or Position : CFO
Name : FELIPE PIA
Credential :
Telephone Number : 904-296-1055
Provider Enumeration Date : 04/18/2006
Last Update Date : 10/08/2019

Similar Medicare Providers

1891328324 — SAMANTHA CARTER
Practice Location Address:
3725 BELFORT RD
JACKSONVILLE, FL
32216-5813
Practice Phone: 904-296-1055
Practice Fax:
1235148149 — MS. CARMELLA MARIA PRESCOTT LMHC
Practice Location Address:
3725 BELFORT RD
JACKSONVILLE, FL
32216-5813
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Practice Fax: 904-448-7700
1255340378 — GREGORY A. KAHRS LCSW
Practice Location Address:
3725 BELFORT RD
JACKSONVILLE, FL
32216-5813
Practice Phone: 904-296-1055
Practice Fax: 904-448-7700
1457360323 — MR. ROBIN ROUNDTREE
Practice Location Address:
3725 BELFORT RD.
JACKSONVILLE, FL
32216-5813
Practice Phone: 904-296-1055
Practice Fax: 904-448-7700
1881709954 — LETITIA LYNNETTE SMILEY B.A.
Practice Location Address:
3725 BELFORT RD
JACKSONVILLE, FL
32216-5813
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1891852166 — VICTORIA LYNN KELLEY
Practice Location Address:
3725 BELFORT RD
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Practice Fax:

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