Provider Demographics
NPI:1497072482
Name:THE JERICHO SCHOOL FOR CHILDREN WITH AUTISM, INC.
Entity Type:Organization
Organization Name:THE JERICHO SCHOOL FOR CHILDREN WITH AUTISM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:904-744-5110
Mailing Address - Street 1:PO BOX 11057
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-1057
Mailing Address - Country:US
Mailing Address - Phone:904-744-5110
Mailing Address - Fax:904-744-3443
Practice Address - Street 1:1351 SPRINKLE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5448
Practice Address - Country:US
Practice Address - Phone:904-744-5110
Practice Address - Fax:904-744-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities