Organization
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Active
Parent organization
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Other names
FAMILY HEALTH SOURCE
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Authorized official
REBECCA COLLIER (CREDENTIALING COORDINATOR)
(386) 202-6025
Entity
Organization
Contact information
Practice address
801 BEVILLE RD STE 101&102, SOUTH DAYTONA, FL 32119-1860
(386) 267-6214
Mailing address
1205 S WOODLAND BLVD STE 3, DELAND, FL 32720-7464
(386) 202-6025
(386) 269-1847
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
687955111
—
FL
Enumeration date
01/30/2017
Last updated
08/10/2021
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