IndividualActive
Alexcia Bennett
NPI 1003637588 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Macclenny, FL
Provider details
- NPI number
- 1003637588
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
- Community Health Worker172V00000X
Other Service Providers
Practice location
505 Matecumbe Ct
Macclenny, FL 32063-8832
Phone: (904) 414-1675
Approximate (ZIP-level) locationGet directions
Mailing address
7645 Gate Pkwy Ste 104-1425
Jacksonville, FL 32256-2889
Registry dates
- Enumerated
- 2024-10-18
- Last updated
- 2024-10-18
- Certified
- 2024-10-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.