Provider Demographics
NPI:1609047018
Name:BIRKMIRE BEHAVIORAL HEALTHCARE JACKSONVILLE, INC
Entity Type:Organization
Organization Name:BIRKMIRE BEHAVIORAL HEALTHCARE JACKSONVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIRKMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-262-0303
Mailing Address - Street 1:1601 DODD RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9357
Mailing Address - Country:US
Mailing Address - Phone:407-332-6506
Mailing Address - Fax:407-830-4073
Practice Address - Street 1:11633 PHILIPS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1641
Practice Address - Country:US
Practice Address - Phone:904-262-0303
Practice Address - Fax:904-262-0909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIRKMIRE BEHAVIORAL HEALTHCARE,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME756801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty