Organization
JACKSONVILLE YOUTH SANCTUARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS HEATHER LYNN COYNE (TARGETED CASE MANAGER)
(904) 866-0425
Entity
Organization
Contact information
Practice address
4570 SAINT JOHNS AVE, SUITE 1, JACKSONVILLE, FL 32210-1848
(904) 389-5231
Mailing address
4570 SAINT JOHNS AVE, SUITE 1, JACKSONVILLE, FL 32210-1848
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
171M00000X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
360358001
—
FL
Enumeration date
07/01/2009
Last updated
07/01/2009
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