Provider Demographics
NPI:1790202711
Name:PEMBERLEY ADMINISTRATIVE SERVICES, LLC
Entity Type:Organization
Organization Name:PEMBERLEY ADMINISTRATIVE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-466-1106
Mailing Address - Street 1:1175 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-9293
Mailing Address - Country:US
Mailing Address - Phone:904-466-1106
Mailing Address - Fax:
Practice Address - Street 1:157 HAMPTON POINT DR STE 1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3054
Practice Address - Country:US
Practice Address - Phone:904-466-1106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)