Provider Demographics
NPI:1598391807
Name:NORTHEAST FLORIDA HEALTHY START COALITION, INC.
Entity Type:Organization
Organization Name:NORTHEAST FLORIDA HEALTHY START COALITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:904-723-5422
Mailing Address - Street 1:644 CESERY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-7165
Mailing Address - Country:US
Mailing Address - Phone:904-723-5422
Mailing Address - Fax:904-723-5433
Practice Address - Street 1:6024 MERRILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3427
Practice Address - Country:US
Practice Address - Phone:904-723-5422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty