Provider Demographics
NPI:1558055129
Name:RIVER CITY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:RIVER CITY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:904-859-7885
Mailing Address - Street 1:12536 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7588
Mailing Address - Country:US
Mailing Address - Phone:904-859-7885
Mailing Address - Fax:
Practice Address - Street 1:12536 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7588
Practice Address - Country:US
Practice Address - Phone:904-859-7885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty