Organization
JACKSONVILLE YOUTH SANCTUARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DANIELLE MARIE BURNS BA (TARGETED CASE MANAGER)
(904) 993-7955
Entity
Organization
Contact information
Practice address
4570 SAINT JOHNS AVE, SUITE 3, JACKSONVILLE, FL 32210-1848
(904) 389-5231
(904) 677-8019
Mailing address
4570 SAINT JOHNS AVE, SUITE 3, JACKSONVILLE, FL 32210-1848
(904) 389-5231
(904) 677-8019
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
171M00000X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
360358001
—
FL
Enumeration date
06/30/2009
Last updated
07/07/2009
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