1497187843 NPI number — HEALTHY SCHOOLS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497187843 NPI number — HEALTHY SCHOOLS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY SCHOOLS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497187843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3546 SAINT JOHNS BLUFF RD S
Provider Second Line Business Mailing Address:
SUITE 113
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32224-2713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-834-2679
Provider Business Mailing Address Fax Number:
904-395-3249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 BRANSCOMB RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
GREEN COVE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32043-7223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-834-2679
Provider Business Practice Location Address Fax Number:
904-395-3249
Provider Enumeration Date:
08/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BOSELLI
Authorized Official First Name:
DON
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-834-2679

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 023777800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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