Provider Demographics
NPI:1154447696
Name:AGENCY FOR PERSONS WITH DISABILITIES
Entity Type:Organization
Organization Name:AGENCY FOR PERSONS WITH DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-955-5575
Mailing Address - Street 1:1621 NE WALDO RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3900
Mailing Address - Country:US
Mailing Address - Phone:352-955-5919
Mailing Address - Fax:352-955-6113
Practice Address - Street 1:1621 NE WALDO RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3900
Practice Address - Country:US
Practice Address - Phone:352-955-5919
Practice Address - Fax:352-955-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9054OtherPROVIDER NUMBER