1710243571 NPI number — CENTER FOR A HEALTHY MIND AND WELLBEING LLC

Table of content: (NPI 1710243571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710243571 NPI number — CENTER FOR A HEALTHY MIND AND WELLBEING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR A HEALTHY MIND AND WELLBEING 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:
1710243571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1677 WELLS RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-6799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-272-0043
Provider Business Mailing Address Fax Number:
904-272-0045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6817 SOUTHPOINT PKWY STE 1301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-6297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-527-8777
Provider Business Practice Location Address Fax Number:
904-379-5744
Provider Enumeration Date:
04/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HUDNALL
Authorized Official First Name:
GINGER
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
904-527-8777

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME108768 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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