Raynyoda Jackson Med Wavier Agency LLC
NPI #1063719136 in High Springs, Florida
Provider Information
- NPI Number
- 1063719136
- Entity Type
- Organization
- Organization Name
- Raynyoda Jackson Med Wavier Agency LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Feb 25, 2011
- Last Updated
- Feb 25, 2011
Practice Location
- Address
- 1230 NW 5TH AVE
- City
- High Springs
- State
- Florida
- ZIP Code
- 32643-0418
- Phone
- (386) 433-0350
Authorized Official
- Name
- MRS. RAYNYODA SHELONDA JACKSON
- Title
- PROVIDER
- Phone
- (386) 433-0350
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Assisted Living Facility |
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