Organization
GRANDMARY'S HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PROF. MARY A ROBINSON (ADMINISTRATOR)
(904) 768-8350
Entity
Organization
Contact information
Practice address
4828 EVANSTON RD, JACKSONVILLE, FL 32208
(904) 768-8350
Mailing address
4828 EVANSTON RD, JACKSONVILLE, JACKSONVILLE, FL 32208-1840
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
59062583
MI
Other
Enumeration date
12/24/2009
Last updated
12/24/2009
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