New Heaven Dominion, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

02084206 Issued in FL

Legal business name

NEW HEAVEN DOMINION, INC

Practice address

9146 Ridge Brier LN
Jacksonville, FL 32225-9325

Phone

(904) 647-6651

Fax

(904) 647-6653

NPI assigned

Sep 8, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Brian Arthur George

Title

Executive Director

Phone

(904) 790-0721

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1220832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221177600000",
    "number": "1265680805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12355 FINNS COVE TRL",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322464198",
            "telephone_number": "904-790-0721",
            "fax_number": "904-619-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9146 RIDGE BRIER LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322259325",
            "telephone_number": "904-647-6651",
            "fax_number": "904-647-6653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW HEAVEN DOMINION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-08",
        "last_updated": "2008-09-12",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-790-0721",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "02084206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.