EISENHOWER JACKSONVILLE GROUP LLC NPI 1417494485

NPI Information

NPI: 1417494485
Provider Name: EISENHOWER JACKSONVILLE GROUP LLC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
2671 HUFFMAN BLVD
JACKSONVILLE, FL
ZIP 32246
Phone: (734) 677-0070
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EISENHOWER JACKSONVILLE GROUP LLC is a mental health (including community mental health center) clinic center in Jacksonville, FL. EISENHOWER JACKSONVILLE GROUP LLC NPI is 1417494485. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

2671 HUFFMAN BLVD
JACKSONVILLE, FL
ZIP 32246-056
Phone: (734) 677-0070
Fax: (734) 677-0890

The provider's authorized official is Ann Pendley .
The authorized official title is President and has the following contact phone number (734) 677-0070.

The enumeration date for this NPI number is 1/27/2017 and was last updated on 9/28/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	2081P0301X	Physical Medicine & Rehabilitation	Brain Injury Medicine	No
2	251B00000X	Case Management		No
3	251S00000X	Community/Behavioral Health		No
4	320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities		No
5	320700000X	Residential Treatment Facility, Physical Disabilities		No
6	320800000X	Community Based Residential Treatment Facility, Mental Illness		No
7	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		No
8	323P00000X	Psychiatric Residential Treatment Facility		No
9	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1558544130	OTHER	FLORIDA	TRANSITIONAL LIVING FACILITY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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