Jacksonville Youth Sanctuary

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

171M00000X Issued in FL

Legal business name

JACKSONVILLE YOUTH SANCTUARY

Practice address

4570 Saint Johns Ave
Suite 1
Jacksonville, FL 32210-1848

Phone

(904) 389-5231

NPI assigned

Jul 1, 2009

Organization subpart

No

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

Authorized official

Name

Miss Heather Lynn Coyne

Title

Targeted Case Manager

Phone

(904) 866-0425

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Jacksonville Youth Sanctuary4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Jacksonville Youth Sanctuary

  • Social Worker
  • Jacksonville, FL
  • NPI 1104054030
  NPD tax ID
• Jacksonville Youth Sanctuary

  • Case Manager/Care Coordinator
  • Jacksonville, FL
  • NPI 1992933964
  NPD tax ID
• World Good News Inc

  • Case Management Agency
  • Jacksonville, FL
  • NPI 1558328666
  NPD tax ID

Locations

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246406400000",
    "number": "1306074141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 SAINT JOHNS AVE",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 SAINT JOHNS AVE",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101848",
            "telephone_number": "904-389-5231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE YOUTH SANCTUARY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-01",
        "last_updated": "2009-07-01",
        "status": "A",
        "authorized_official_last_name": "COYNE",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "TARGETED CASE MANAGER",
        "authorized_official_telephone_number": "904-866-0425",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "FL",
            "license": "171M00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360358001",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacksonville Wellness Center
• Jacksonville Wellness Center & Preventive Medicine Clinic
• Jacksonville Wolfson Childrens Hospital
• Jacksonville Youth Center
• Jacksonville Youth Sanctuary
• Jacksonville Youth Sanctuary
• Jacksonvillle Acupuncture Clinic, PA
• Lince Jacob
• Rafik Jacob, M.D.
• Dominic River Jacobs Stokes

• Case Management Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Case Management Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2009; 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.