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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063719136 | NPPES |
| Florida | MEDICAID | 691654696 | |
| Florida | MEDICAID | 691654603 | |
| Florida | MEDICAID | 691654698 | |
| Florida | Other | 6906358 |
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