NPIMap

Organization Active NPI

Jacksonville Youth Sanctuary

  • Case Manager/Care Coordinator
  • Jacksonville, FL
National Provider Identifier
1992933964
Registry record updated Aug 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Legal business name
JACKSONVILLE YOUTH SANCTUARY
Practice address
4570 Saint Johns Ave Ste 3
Jacksonville, FL 32210-1844
Phone
(904) 389-5231
Fax
(904) 677-8019
NPI assigned
Jun 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2009

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

Authorized official

Name
Jennifer G Rousset
Title
Targeted Case Manager
Phone
(904) 389-5231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X FL Primary

Addresses

Primary practice location

4570 Saint Johns Ave Ste 3
Jacksonville, FL 32210-1844

Mailing address

4570 Saint Johns Ave Ste 3
Jacksonville, FL 32210-1844
Phone (904) 389-5231

Other identifiers 1

IdentifierTypeStateIssuer
360358001MedicaidFL

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250035200000",
    "number": "1992933964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 SAINT JOHNS AVE STE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101844",
            "telephone_number": "904-389-5231",
            "fax_number": "904-677-8019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 SAINT JOHNS AVE STE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101844",
            "telephone_number": "904-389-5231",
            "fax_number": "904-677-8019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE YOUTH SANCTUARY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-29",
        "last_updated": "2009-08-12",
        "status": "A",
        "authorized_official_last_name": "ROUSSET",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "TARGETED CASE MANAGER",
        "authorized_official_telephone_number": "904-389-5231"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360358001",
            "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 Aug 12, 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.