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/CONTRACTS ADMIN)
(386) 202-6025
Entity
Organization
Contact information
Practice address
1200 DELTONA BLVD, DELTONA, FL 32725-6306
(386) 202-6025
Mailing address
1205 S WOODLAND BLVD STE 3, DELAND, FL 32720-7464
(386) 202-6025
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
687955119
—
FL
Enumeration date
08/22/2019
Last updated
08/10/2021
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