# JACKSONVILLE YOUTH SANCTUARY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306074141
- **Authorized official:** MISS HEATHER LYNN COYNE (TARGETED CASE MANAGER)
- **Authorized official phone:** (904) 866-0425

## Contact information

- **Practice address:** 4570 SAINT JOHNS AVE, SUITE 1, JACKSONVILLE, FL 32210-1848
- **Practice address phone:** (904) 389-5231
- **Mailing address:** 4570 SAINT JOHNS AVE, SUITE 1, JACKSONVILLE, FL 32210-1848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | 171M00000X | FL | Yes |

## Other

- **Enumeration date:** 07/01/2009
- **Last updated:** 07/01/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 360358001 | — | FL |