NPIMap

Organization Active NPI

Northwest Behavioral Health Services, Inc.

  • Community/Behavioral Health Agency
  • Jacksonville, FL
National Provider Identifier
1023016839
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC.
Practice address
2392 Edgewood Ave N
Jacksonville, FL 32254-1725
Phone
(904) 781-7797
Fax
(904) 781-8685
NPI assigned
Jul 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Terri D Glover, MA
Title
Executive Director, Ceo
Phone
(904) 781-0600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X FL
Developmentally Disabled Services Day Training Agency 251C00000X FL
Community/Behavioral Health Agency 251S00000X FL Primary

Addresses

Primary practice location

2392 Edgewood Ave N
Jacksonville, FL 32254-1725

Mailing address

2392 Edgewood Ave N
Jacksonville, FL 32254-1725
Phone (904) 781-0600

Other identifiers 4

IdentifierTypeStateIssuer
029591400MedicaidFL
029591401MedicaidFL
284275OtherFLHMO
681396800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130905000410 FL Part B Supplier - Clinic/Group Practice 5597919639 Receives reassigned benefits from 2 practitioners
Practice locations: Hilliard, FL; Jacksonville, FL

National Provider Directory

National Provider Directory
Tax ID family
North West Behaviorial3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15891 County Road 108
Hilliard, FL 32046
Phone (904) 675-9140

551856 US Highway 1
Ste 109
Hilliard, FL 32046
Phone (904) 845-4008

2400 Edgewood Ave N
Jacksonville, FL 32254
Phone (904) 568-8299

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1023016839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2392 EDGEWOOD AVE N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322541725",
            "telephone_number": "904-781-0600",
            "fax_number": "904-781-8685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2392 EDGEWOOD AVE N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322541725",
            "telephone_number": "904-781-7797",
            "fax_number": "904-781-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST BEHAVIORAL HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR, CEO",
        "authorized_official_telephone_number": "904-781-0600",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029591400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029591401",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO",
            "identifier": "284275",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "681396800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.