# JRA ADULT FAMILY CARE HOME

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

## Provider details

- **NPI number:** 1356778526
- **Authorized official:** JOSEPH ALEX APOLLON (PRESIDENT & CEO)
- **Authorized official phone:** (386) 931-9871

## Contact information

- **Practice address:** 41 WOODLAWN DR, PALM COAST, FL 32164
- **Practice address phone:** (386) 931-9871
- **Practice address fax:** (386) 585-4962
- **Mailing address:** 41 WOODLAWN DR, PALM COAST, FL 32164-7915
- **Mailing address phone:** (386) 931-9871
- **Mailing address fax:** (386) 585-4962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 6906482 | FL | Yes |

## Other

- **Enumeration date:** 10/03/2013
- **Last updated:** 10/03/2013