Organization
HOME AWAY FROM HOME OF PUTNAM CO., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA JACKSON (PRESIDENT)
(386) 329-3208
Entity
Organization
Contact information
Practice address
680 OLD SAN MATEO RD, SAN MATEO, FL 32187-2220
(386) 329-3208
(386) 385-3248
Mailing address
3108 SAINT JOHNS AVE, PALATKA, FL 32177-4132
(386) 385-3166
(386) 385-3248
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
09/15/2025
Last updated
09/15/2025
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