MEDICARE: TURNAROUND RETREAT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1730650573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TURNAROUND RETREAT

Provider Business Mailing Address
First Line	:	1159 E 13TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-3105
Country	:	US
Telephone Number	:	904-660-8835
Fax Number	:

Provider Business Practice Location Address
First Line	:	1159 E 13TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-3105
Country	:	US
Telephone Number	:	904-660-8835
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TONEESHA SINGLETON
Credential	:
Telephone Number	:	904-305-8828

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	12/05/2018

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