Organization
NEW JERUSALEM TRANSITIONAL HOUSING LLC
Active
Organization
NEW JERUSALEM TRANSITIONAL HOUSING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DE'ARIS WILLIAM HENRY SR. (MEDICAID)
(904) 834-1113
Entity
Organization
Contact information
Practice address
2041 TALLADEGA RD, JACKSONVILLE, FL 32209-2639
(904) 834-1113
Mailing address
2041 TALLADEGA RD, JACKSONVILLE, FL 32209-2639
(904) 834-1113
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
06/30/2023
Last updated
06/30/2023
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