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Organization

AGENCY FOR PERSONS WITH DISABILITIES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. DEBRA A JACKSON (C.F.O.)
(352) 955-5575
Entity
Organization

Contact information

Practice address
1621 NE WALDO RD, GAINESVILLE, FL 32609-3900
(352) 955-5919
(352) 955-6113
Mailing address
1621 NE WALDO RD, GAINESVILLE, FL 32609-3900
(352) 955-5919
(352) 955-6113

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
K9054
PROVIDER NUMBER
FL
Enumeration date
03/22/2007
Last updated
08/22/2020
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