Active NPI
Ten Broeck Jacksonville LLC
- Psychiatric Hospital
- Jacksonville, FL
National Provider Identifier
1497758312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric Hospital
- License
- 4011
- Legal business name
- TEN BROECK JACKSONVILLE LLC
- Practice address
- 6300 Beach Blvd
Jacksonville, FL 32216-2708 - Phone
- (904) 724-9202
- Fax
- (904) 724-3797
- NPI assigned
- May 24, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. David Corddry
- Title
- Vice President of Finance
- Phone
- (407) 876-2200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital | 283Q00000X | 4011 | FL | Primary |
Addresses
Primary practice location
6300 Beach Blvd
Jacksonville, FL 32216-2708
Mailing address
6300 Beach Blvd
Jacksonville, FL 32216-2708
Phone (904) 724-9202
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 075144816 | Medicaid | FL |
National Provider Directory
National Provider Directory- Tax ID family
- TBJ Behavioral Center LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Psychiatric Hospital
- Jacksonville, FL
- NPI 1568633683
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1210204800000",
"number": "1497758312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6300 BEACH BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322162708",
"telephone_number": "904-724-9202",
"fax_number": "904-724-3797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6300 BEACH BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322162708",
"telephone_number": "904-724-9202",
"fax_number": "904-724-3797"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TEN BROECK JACKSONVILLE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-05-24",
"last_updated": "2008-05-08",
"status": "A",
"authorized_official_last_name": "CORDDRY",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
"authorized_official_telephone_number": "407-876-2200",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "283Q00000X",
"taxonomy_group": "",
"desc": "Psychiatric Hospital",
"state": "FL",
"license": "4011",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "075144816",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
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- Melissa Templeton, MSN, ARNP, FNP-C
- Susan Gorodetzky Templo, ARNP
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- Tender Helping Hands LLL
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.