Provider Demographics
NPI:1659520047
Name:HALE, JOHN CALVIN (CASE MANAGER)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CALVIN
Last Name:HALE
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 BEECHWOOD ST
Mailing Address - Street 2:623 BEECHWOOD ST
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-6236
Mailing Address - Country:US
Mailing Address - Phone:904-358-1211
Mailing Address - Fax:904-358-1551
Practice Address - Street 1:623 BEECHWOOD ST
Practice Address - Street 2:623 BEECHWOOD ST
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-6236
Practice Address - Country:US
Practice Address - Phone:904-358-1211
Practice Address - Fax:904-358-1551
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator