Organization
EISENHOWER JACKSONVILLE GROUP LLC
Active
Parent organization
MORIAH INCOORPORATED
Organization subpart
Yes
Provider details
NPI number
Legal business name
MORIAH INCOORPORATED
Authorized official
MR. ANN PENDLEY MSN (PRESIDENT)
(734) 677-0070
Entity
Organization
Contact information
Practice address
2671 HUFFMAN BLVD, JACKSONVILLE, FL 32246-4056
(734) 677-0070
(734) 677-0890
Mailing address
2671 HUFFMAN BLVD, JACKSONVILLE, FL 32246-4056
(734) 677-0070
(734) 677-0890
Taxonomy
Speciality
Code
Description
License number
State
2081P0301X
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558544130
TRANSITIONAL LIVING FACILITY
FL
Enumeration date
01/27/2017
Last updated
09/28/2021
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