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CH0423770 NORTHEAST FLORIDA HEALTH SERVICES, INC. (Active)
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Main Details
Name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Subdivision Name
PIERSON Family Health Source
Type
HRSA-Funded Health Center
Site ID
BPS-H80-008206
340B ID
CH0423770
Grant Number
H80CS02520
Additional Details
Current Program Status
Active
Registration Date
10/1/2004
Participating Start Date
10/1/2004
Participating Approval Date
8/23/2004
Last Recertification Date
2/20/2025
Contacts
Authorizing Official
Northeast Florida Health Services, inc,
Laurie Asbury, CEO
(386) 624-1054
Primary Contact
Family Health Source
Hipolito Valdez, CFO
(386) 414-9601
Addresses
Street Address
216 N. FREDERICK ST.
PIERSON, FL 32180
Billing Address
Northeast Florida Health Services, Inc.
1205 South Woodland Boulevard
Suite 3
DeLand, FL 32720
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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11/16/09 UPDATED ADDR (WAS 114 N VOLUSIA AVE)
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