Provider Demographics
NPI:1265585806
Name:THE NEMOURS FOUNDATION
Entity type:Organization
Organization Name:THE NEMOURS FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKENDREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-697-5628
Mailing Address - Street 1:10140 CENTURION PARKWAY N
Mailing Address - Street 2:C/O MANAGED CARE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:807 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8426
Practice Address - Country:US
Practice Address - Phone:904-697-3600
Practice Address - Fax:904-697-3927
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE NEMOURS FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0200X, 261QE0700X, 261QG0250X, 261QH0700X, 261QM0855X, 261QM2500X, 261QX0200X, 261QR1100X, 261QD1600X, 103K00000X, 261QM1300X
FL261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061950729Medicaid
FL061950721Medicaid
FL061950700Medicare ID - Type UnspecifiedGROUP ID
FL061950729Medicaid
FL061950721Medicaid
FL00763Medicare ID - Type UnspecifiedGROUP ID