MEDICARE: NORTHWEST BEHAVIORAL HEALTH

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	251B00000X	Case Management Agency		FL

General Provider Information

NPI Number	:	1972524684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	2392 EDGEWOOD AVE N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-1725
Country	:	US
Telephone Number	:	904-781-7797
Fax Number	:	904-781-8729

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	:	904-781-8729

Authorized Official
Title or Position	:	CEO
Name	:	MS. PATRICIA G SAMPSON
Credential	:	MS, CAPP
Telephone Number	:	904-781-7797

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1023016839 — NORTHWEST BEHAVIORAL HEALTH SERVICES, INC.
Practice Location Address:

2392 EDGEWOOD AVE N
JACKSONVILLE, FL
32254-1725

Practice Phone: 904-781-7797
Practice Fax: 904-781-8685

1518919471 — JAMES RIPPA DC
Practice Location Address:

2396 EDGEWOOD AVE N
JACKSONVILLE, FL
32254-1725

Practice Phone: 904-781-2300
Practice Fax: 904-781-3502

1851317374 — MS. PATRICIA GAIL SAMPSON M.S., CAPP
Practice Location Address:

2392 EDGEWOOD AVE N
JACKSONVILLE, FL
32254-1725

Practice Phone: 904-781-7797
Practice Fax: 904-781-8729

1609911684 — DR. JAMES C. ROBINSON D.C.
Practice Location Address:

2396 EDGEWOOD AVE N
JACKSONVILLE, FL
32254-1725

Practice Phone: 904-781-2300
Practice Fax: 904-781-3502

1285779348 — NORTHWEST BEHAVIORAL HEALTH SERVICES, INC
Practice Location Address:

2392 EDGEWOOD AVE N
JACKSONVILLE, FL
32254-1725

Practice Phone: 904-781-7797
Practice Fax:

1932232139 — KEVIN LARON BROOKS B.S.
Practice Location Address:

2392 EDGEWOOD AVE N
JACKSONVILLE, FL
32254-1725

Practice Phone: 904-781-7797
Practice Fax:

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