Provider Demographics
NPI:1114403185
Name:FAMILY FIRST SOLUTION COMMUNITY DEVELOPMENT CORP
Entity Type:Organization
Organization Name:FAMILY FIRST SOLUTION COMMUNITY DEVELOPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASZLOYN
Authorized Official - Middle Name:NIKITA
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:904-622-8684
Mailing Address - Street 1:12280 SUMTER SQUARE DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6125
Mailing Address - Country:US
Mailing Address - Phone:904-622-8684
Mailing Address - Fax:
Practice Address - Street 1:12280 SUMTER SQUARE DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218
Practice Address - Country:US
Practice Address - Phone:904-622-8684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
FL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018486300Medicaid