Provider Demographics
NPI:1649854555
Name:JASON'S PLACE AJA LLC
Entity type:Organization
Organization Name:JASON'S PLACE AJA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-994-0921
Mailing Address - Street 1:12298 LYSTERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5313
Mailing Address - Country:US
Mailing Address - Phone:904-994-0921
Mailing Address - Fax:
Practice Address - Street 1:12298 LYSTERFIELD CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-5313
Practice Address - Country:US
Practice Address - Phone:904-994-0921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASON'S PLACE AJA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty