Provider Demographics
NPI:1720606684
Name:JAZZY Z SAFE HAVEN
Entity Type:Organization
Organization Name:JAZZY Z SAFE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAZMINE
Authorized Official - Middle Name:ARIANA
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-422-6888
Mailing Address - Street 1:7283 NOTTINGHAMSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-4324
Mailing Address - Country:US
Mailing Address - Phone:904-422-6888
Mailing Address - Fax:
Practice Address - Street 1:7283 NOTTINGHAMSHIRE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-4324
Practice Address - Country:US
Practice Address - Phone:904-422-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106198800Medicaid