NPIMap

Organization Active NPI

Mental Health Center of Jacksonville, Inc.

  • Community Health Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1366558132
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
MENTAL HEALTH CENTER OF JACKSONVILLE, INC.
Practice address
3333 W 20TH St
Jacksonville, FL 32254-1703
Phone
(904) 695-9145
Fax
(904) 695-2465
NPI assigned
Aug 22, 2006
Reactivated
Jan 2, 2015
Last updated
Jan 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Authorized official

Name
Mr. Robert Sommers, PH.D.
Title
President and Ceo
Phone
(904) 743-1883

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community Health Clinic/Center 261QC1500X Primary
Psychiatric Hospital 283Q00000X

Addresses

Primary practice location

3333 W 20TH St
Jacksonville, FL 32254-1703

Mailing address

PO Box 19189
Jacksonville, FL 32245-9189
Phone (904) 743-1883

Other identifiers 2

IdentifierTypeStateIssuer
060366000MedicaidFL
060366002MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1366558132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19189",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322459189",
            "telephone_number": "904-743-1883",
            "fax_number": "904-743-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 W 20TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322541703",
            "telephone_number": "904-695-9145",
            "fax_number": "904-695-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL HEALTH CENTER OF JACKSONVILLE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2015-01-26",
        "deactivation_date": "2014-12-29",
        "reactivation_date": "2015-01-02",
        "status": "A",
        "authorized_official_last_name": "SOMMERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "904-743-1883",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060366000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060366002",
            "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 Jan 26, 2015; 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.