Eisenhower Jacksonville Group LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

EISENHOWER JACKSONVILLE GROUP LLC

Practice address

2671 Huffman Blvd
Jacksonville, FL 32246-4056

Phone

(734) 677-0070

Fax

(734) 677-0890

NPI assigned

Jan 27, 2017

Last updated

Sep 28, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

MORIAH INCOORPORATEDAs reported in NPPES

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

Authorized official

Name

Mr. Ann Pendley, MSN

Title

President

Phone

(734) 677-0070

Specialties & licenses 9

Addresses

Other identifiers 1

Part of

Moriah Incorporated

Locations

Practitioners 4

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.

• Stephanie Marie Coffey, RN

  • Registered Nurse
  • Jacksonville, FL
  • NPI 1174218903
  NPD
• Jeremy Daniels, BCBA, IBA, LBA-VA

  • Behavior Analyst
  • Stuart, FL
  • NPI 1972279495
  NPD
• Siobhan Stewart

  • Behavior Technician
  • Jacksonville, FL
  • NPI 1548078629

  Community/Behavioral Health

  NPD
• Kacey Yourous

  • Developmental Therapist
  • Jacksonville, FL
  • NPI 1669843009
  NPD (past)

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

{
    "created_epoch": "1485475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1417494485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2671 HUFFMAN BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322464056",
            "telephone_number": "734-677-0070",
            "fax_number": "734-677-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2671 HUFFMAN BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322464056",
            "telephone_number": "734-677-0070",
            "fax_number": "734-677-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EISENHOWER JACKSONVILLE GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MORIAH INCOORPORATED",
        "enumeration_date": "2017-01-27",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "PENDLEY",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-677-0070",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "2081P0301X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Brain Injury Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRANSITIONAL LIVING FACILITY",
            "identifier": "1558544130",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eighth Street Foot and Ankle LLC
• Kara Marie Eiginger, RN
• Maryann Solt Eisemann, REGISTERED NURSE
• David J Eisen, M.D.
• Iris Eisenberg, MD
• Cynthia Eisman, PTA
• Tracey J Eismont, PA
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• Mental Health Clinic/Center (Including Community Mental Health Center) in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; 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.