Provider Demographics
NPI:1043876378
Name:JONES, R. DAVID (RN, OPERATIONS MGR)
Entity Type:Individual
Prefix:
First Name:R. DAVID
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:RN, OPERATIONS MGR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2877
Mailing Address - Country:US
Mailing Address - Phone:954-815-4967
Mailing Address - Fax:754-200-5155
Practice Address - Street 1:2020 E OAKLAND PARK BLVD STE B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1106
Practice Address - Country:US
Practice Address - Phone:754-779-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12874101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty