Provider Demographics
NPI:1376769596
Name:URBAN JACKSONVILLE, INC
Entity type:Organization
Organization Name:URBAN JACKSONVILLE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-807-1240
Mailing Address - Street 1:4250 LAKESIDE DR STE 116
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3300
Mailing Address - Country:US
Mailing Address - Phone:904-807-1203
Mailing Address - Fax:904-807-1220
Practice Address - Street 1:604 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-3322
Practice Address - Country:US
Practice Address - Phone:904-284-3134
Practice Address - Fax:904-284-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05912800Medicaid
FL023516401Medicaid
FL023516403Medicaid