Organization
ST JOHN SUPPORT SERVICES, INC
Active
Organization
ST JOHN SUPPORT SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA A ISHMAN-HOLT (OWNER)
(904) 768-6116
Entity
Organization
Contact information
Practice address
435 CLARK RD STE 408-3, JACKSONVILLE, FL 32218-8505
(904) 768-6116
(904) 713-0307
Mailing address
435 CLARK RD STE 408-3, JACKSONVILLE, FL 32218-8505
(904) 768-6116
(904) 713-0307
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6917585-96
—
FL
05
—
6917585-98
—
FL
Enumeration date
06/18/2008
Last updated
06/18/2008
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