Organization
ALLIED HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVONTA J JACKSON (OWNER)
(832) 490-8067
Entity
Organization
Contact information
Practice address
7235 BONNEVAL RD, JACKSONVILLE, FL 32256-7565
(904) 309-2422
Mailing address
19925 SUTTON FALLS DR, CYPRESS, TX 77433-1026
(832) 490-8067
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
02/11/2016
Last updated
02/16/2016
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