Organization
ACUTE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAVEN MAYES (CEO)
(352) 792-8069
Entity
Organization
Contact information
Practice address
4170 SW 13TH ST, GAINESVILLE, FL 32608-4002
(352) 374-5600
Mailing address
PO BOX 5393, GAINESVILLE, FL 32627-5393
(352) 792-8069
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QA0005X
Ambulatory Family Planning Facility
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QE0002X
Emergency Care Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QV0200X
VA Clinic/Center
—
—
347B00000X
Bus
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05
—
FL
Enumeration date
10/18/2021
Last updated
10/18/2021
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