Individual
SAMANTHA S WARFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8071 BEAVER CREEK DR, JACKSONVILLE, FL 32210-9772
(904) 536-4015
Mailing address
8071 BEAVER CREEK DR, JACKSONVILLE, FL 32210-9772
(904) 536-4015
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107979400
—
FL
Enumeration date
11/19/2020
Last updated
11/19/2020
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