Provider Demographics
NPI:1841751070
Name:DAYSPRING VILLAGE, INC.
Entity Type:Organization
Organization Name:DAYSPRING VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-845-7501
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:FL
Mailing Address - Zip Code:32046-1080
Mailing Address - Country:US
Mailing Address - Phone:904-845-7501
Mailing Address - Fax:
Practice Address - Street 1:554820 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:FL
Practice Address - Zip Code:32046-2846
Practice Address - Country:US
Practice Address - Phone:904-845-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAYSPRING VILLAGE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140217000Medicaid