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Mary Imhansiemhonehi
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Jacksonville, Florida
NPI 1235786856

Mary Imhansiemhonehi is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Jacksonville, FL. Mary Imhansiemhonehi practices in Jacksonville, FL. The NPI Number for Mary Imhansiemhonehi is 1235786856 and holds a License No. (Florida).

The current practice location address for Mary Imhansiemhonehi is 4568 Antler Hill Dr E, Jacksonville, FL and can be reached out via phone at 386-265-8778.

Location: 4568 Antler Hill Dr E, Jacksonville, FL, 32224-8704
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1235786856
Provider Name
Mary Imhansiemhonehi
Credential
Provider Entity Type
Individual
Gender
Female
Address
4568 Antler Hill Dr E, Jacksonville, FL, 32224-8704
Phone Number
386-265-8778
Fax Number
Provider Enumeration Date
08/19/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
4568 Antler Hill Dr E
City
Jacksonville
State
Florida
Zip
32224-8704
Phone Number
386-265-8778
Fax Number
person
Provider Business Mailing Address Details
Address
4568 Antler Hill Dr E
City
Jacksonville
State
Florida
Zip
32224-8704
Phone Number
386-265-8778
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
()
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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