Individual
MARY IMHANSIEMHONEHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4568 ANTLER HILL DR E, JACKSONVILLE, FL 32224-8704
(386) 265-8778
Mailing address
4568 ANTLER HILL DR E, JACKSONVILLE, FL 32224-8704
(386) 265-8778
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/19/2019
Last updated
08/19/2019
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