Organization
SHARONDA R. HUSSEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHARONDA HUSSEY (PROVIDER)
(904) 229-1884
Entity
Organization
Contact information
Practice address
11501 BRIAN LAKES DR, JACKSONVILLE, FL 32221-2849
(904) 229-1884
Mailing address
11501 BRIAN LAKES DR, JACKSONVILLE, FL 32221-2849
(904) 229-1884
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015805400
—
FL
Enumeration date
12/02/2015
Last updated
12/02/2015
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