Provider Demographics
NPI:1346205861
Name:DANIEL MEMORIAL, INC.
Entity Type:Organization
Organization Name:DANIEL MEMORIAL, INC.
Other - Org Name:DANIEL
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-296-1055
Mailing Address - Street 1:4203 SOUTHPOINT BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6164
Mailing Address - Country:US
Mailing Address - Phone:904-296-1055
Mailing Address - Fax:904-296-1953
Practice Address - Street 1:3725 BELFORT RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5813
Practice Address - Country:US
Practice Address - Phone:904-296-1055
Practice Address - Fax:904-448-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060849102Medicaid
FL060849116Medicaid
FL060849103Medicaid
FL060849100Medicaid