Organization
OWL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LASTER BERNARD WALKER PHD (PRESIDENT/CEO)
(904) 755-4720
Entity
Organization
Contact information
Practice address
87 COLES CT, SAINT JOHNS, FL 32259-8898
(904) 755-4720
Mailing address
87 COLES CT, SAINT JOHNS, FL 32259-8898
(904) 755-4720
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
347B00000X
Bus
—
—
347C00000X
Private Vehicle
—
—
347E00000X
Transportation Broker
—
—
Other
Enumeration date
06/03/2013
Last updated
02/21/2019
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