Organization
WINCHESTER OAKS CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CICELY JACKSON (OWNER)
(386) 759-0353
Entity
Organization
Contact information
Practice address
871 WINCHESTER ST, DAYTONA BEACH, FL 32114-1977
(386) 795-0353
Mailing address
871 WINCHESTER ST, DAYTONA BEACH, FL 32114-1977
(386) 795-0353
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
FL
Enumeration date
08/17/2020
Last updated
08/17/2020
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