Provider Demographics
NPI:1093593709
Name:NORTH FLORIDA HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:NORTH FLORIDA HEALTH CENTER, INC.
Other - Org Name:NORTH FLORIDA HEALTH CENTER, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LACASSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-590-7096
Mailing Address - Street 1:1372 OHIO AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064
Mailing Address - Country:US
Mailing Address - Phone:386-590-7096
Mailing Address - Fax:
Practice Address - Street 1:1373 OHIO AVE NORTH
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064
Practice Address - Country:US
Practice Address - Phone:386-590-7096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)