Organization
MEDALLION HEALTH CRAE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEONA BARNWELL (CEO)
(904) 371-2800
Entity
Organization
Contact information
Practice address
9951 ATLANTIC BLVD, SUITE 319, JACKSONVILLE, FL 32225-6584
(904) 371-2800
Mailing address
9951 ATLANTIC BLVD, SUITE 319, JACKSONVILLE, FL 32225-6584
(904) 371-2800
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000661201
—
FL
Enumeration date
04/27/2015
Last updated
04/27/2015
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