Provider Demographics
NPI:1780198432
Name:JJ SHERRITA WHOLELISTIC SERVICES LLC
Entity Type:Organization
Organization Name:JJ SHERRITA WHOLELISTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-438-3744
Mailing Address - Street 1:5415 HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1456
Mailing Address - Country:US
Mailing Address - Phone:321-438-3744
Mailing Address - Fax:
Practice Address - Street 1:5415 HYDE PARK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1456
Practice Address - Country:US
Practice Address - Phone:321-438-3744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities