Provider Demographics
NPI:1952074510
Name:MARLYN ENTERPRISES OF JACKSONVILLE, INC.
Entity Type:Organization
Organization Name:MARLYN ENTERPRISES OF JACKSONVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ULERIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-398-2020
Mailing Address - Street 1:11265 ALUMNI WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7630
Mailing Address - Country:US
Mailing Address - Phone:904-398-2020
Mailing Address - Fax:904-724-2172
Practice Address - Street 1:179 WELLS RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3057
Practice Address - Country:US
Practice Address - Phone:904-579-4614
Practice Address - Fax:904-724-2174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARLYN ENTERPRISES OF JACKSONVILLE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health