Organization
JACKSONVILLE YOUTH SANCTUARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER G ROUSSET (TARGETED CASE MANAGER)
(904) 389-5231
Entity
Organization
Contact information
Practice address
4570 SAINT JOHNS AVE STE 3, JACKSONVILLE, FL 32210-1844
(904) 389-5231
(904) 677-8019
Mailing address
4570 SAINT JOHNS AVE STE 3, JACKSONVILLE, FL 32210-1844
(904) 389-5231
(904) 677-8019
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
360358001
—
FL
Enumeration date
06/29/2009
Last updated
08/12/2009
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