Organization
TEN BROECK JACKSONVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID CORDDRY (VICE PRESIDENT OF FINANCE)
(407) 876-2200
Entity
Organization
Contact information
Practice address
6300 BEACH BLVD, JACKSONVILLE, FL 32216-2708
(904) 724-9202
(904) 724-3797
Mailing address
6300 BEACH BLVD, JACKSONVILLE, FL 32216-2708
(904) 724-9202
(904) 724-3797
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
4011
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075144816
—
FL
Enumeration date
05/24/2005
Last updated
05/08/2008
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