Provider Demographics
NPI:1518468446
Name:JENESYS HEARTS, LLC
Entity Type:Organization
Organization Name:JENESYS HEARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANCHETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LCSW
Authorized Official - Phone:904-866-6961
Mailing Address - Street 1:PO BOX 440605
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-0007
Mailing Address - Country:US
Mailing Address - Phone:904-866-6961
Mailing Address - Fax:
Practice Address - Street 1:8597 FALLING SPRINGS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-8461
Practice Address - Country:US
Practice Address - Phone:904-866-6961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW14369104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty