Raynyoda Jackson Med Wavier Agency Llc

LBN: Raynyoda Jackson Med Wavier Agency Llc
Raynyoda Jackson Med Wavier Agency Llc is an health care organization with primary practice located at 1230 Nw 5Th Ave , High Springs FL 32643-0418. The organization recently has 2 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Assisted Living Facility, Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities. Nursing & Custodial Care Facilities / Assisted Living Facility is the primary health care specialty. Raynyoda Jackson Med Wavier Agency Llc can be contacted via phone (386) 433-0350, or through Jackson, Raynyoda Shelonda via phone (386) 433-0350.

Contact Information

Primary practice address
1230 Nw 5Th Ave High Springs FL 32643-0418
Phone: (386) 433-0350
Fax: (385) 454-4288
Website:
Map and Directions
Authorized official contact:
Name: Jackson, Raynyoda Shelonda
Phone: (386) 433-0350

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X 6906358 Florida
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X

Profile Details

NPI number 1063719136
LBN Legal business name Raynyoda Jackson Med Wavier Agency Llc
DBA Doing business as
Authorized official Jackson, Raynyoda Shelonda
Entity Organization
Organization subpart 1 No
Enumeration date Feb 25th, 2011
Last updated Feb 25th, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063719136 NPPES
Florida MEDICAID 691654696
Florida MEDICAID 691654603
Florida MEDICAID 691654698
Florida Other 6906358

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