Provider Demographics
NPI:1356778526
Name:JRA ADULT FAMILY CARE HOME
Entity type:Organization
Organization Name:JRA ADULT FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:APOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-931-9871
Mailing Address - Street 1:41 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7915
Mailing Address - Country:US
Mailing Address - Phone:386-931-9871
Mailing Address - Fax:386-585-4962
Practice Address - Street 1:41 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-931-9871
Practice Address - Fax:386-585-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906482320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities