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Raynyoda Jackson Med Wavier Agency Llc
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in High Springs, Florida
NPI 1063719136

Raynyoda Jackson Med Wavier Agency Llc is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in High Springs, FL. Raynyoda Jackson Med Wavier Agency Llc practices in High Springs, FL. The NPI Number for Raynyoda Jackson Med Wavier Agency Llc is 1063719136 and holds a License No. 6906358 (Florida).

The current practice location address for Raynyoda Jackson Med Wavier Agency Llc is 1230 Nw 5Th Ave, High Springs, FL and can be reached out via phone at 386-433-0350 and via fax at 385-454-4288.

Location: 1230 Nw 5Th Ave, High Springs, FL, 32643-0418
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1063719136
Provider Name
Raynyoda Jackson Med Wavier Agency Llc
Credential
Provider Entity Type
Organization
Address
1230 Nw 5Th Ave, High Springs, FL, 32643-0418
Phone Number
386-433-0350
Fax Number
385-454-4288
Provider Enumeration Date
02/25/2011
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
691654696 05 FL
691654603 05 FL
691654698 05 FL
6906358 01 FL ADULT FAMILY CARE HOME PROVIDER LICENSE NUMBER
institution
Provider Business Practice Location Address Details
Address
1230 Nw 5Th Ave
City
High Springs
State
Florida
Zip
32643-0418
Phone Number
386-433-0350
Fax Number
385-454-4288
person
Provider Business Mailing Address Details
Address
1230 Nw 5Th Ave
City
High Springs
State
Florida
Zip
32643-0418
Phone Number
386-433-0350
Fax Number
385-454-4288
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Assisted Living Facility
Speciality
-
Taxonomy
310400000X
License No.
()
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
6906358 (Florida)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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