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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