Provider Demographics
NPI:1538117858
Name:FAMILY FOUNDATIONS OF NORTHEAST FLORIDA, INC
Entity Type:Organization
Organization Name:FAMILY FOUNDATIONS OF NORTHEAST FLORIDA, INC
Other - Org Name:FAMILY FOUNDATIONS OF NORTHEAST FLORIDA, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-396-8127
Mailing Address - Street 1:40 E ADAMS ST STE LL15
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3353
Mailing Address - Country:US
Mailing Address - Phone:904-396-4846
Mailing Address - Fax:904-398-6649
Practice Address - Street 1:40 E ADAMS ST STE LL15
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3353
Practice Address - Country:US
Practice Address - Phone:904-396-4846
Practice Address - Fax:904-398-6649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX0016Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER