Organization
LAVON M. GAINEY
Active
Other names
Quality Life Center of Jacksonville
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS DE CARVALHO M.D. (MEDICAL DIRECTOR)
(904) 398-2020
Entity
Organization
Contact information
Practice address
11265 ALUMNI WAY, JACKSONVILLE, FL 32246-6685
(904) 518-6090
Mailing address
11265 ALUMNI WAY, JACKSONVILLE, FL 32246-6685
(904) 518-6090
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MH13303
MENTAL HEALTH LICENSURE #
FL
Enumeration date
08/01/2016
Last updated
08/01/2016
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