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RAYNYODA JACKSON MED WAVIER AGENCY LLC
NPI 1063719136
Assisted Living Facility in High Springs, FL

Active since February 25, 2011
1230 NW 5TH AVE, HIGH SPRINGS, FL 32643(386) 433-0350(385) 454-4288 Get Directions Write a Review

NPPES record last updated: February 25, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Raynyoda Jackson Med Wavier Agency Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RAYNYODA JACKSON MED WAVIER AGENCY LLC (NPI 1063719136) is a healthcare organization registered as an assisted living facility in High Springs, Florida and active in the NPI registry since February 2011. The organization lists Raynyoda Shelonda Jackson, Provider, as its authorized official.

NPPES Registry Identity

NPI1063719136
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameRAYNYODA JACKSON MED WAVIER AGENCY LLC
Location Address1230 NW 5TH AVEHigh Springs, FL 32643-0418
Mailing Address1230 Nw 5th Ave, Po Box 2634High Springs, FL 32643-0418 · (386) 433-0350 · Fax (385) 454-4288
Phone(386) 433-0350
Fax(385) 454-4288
Organization SubpartNo
Authorized OfficialRaynyoda Shelonda JacksonProvider · (386) 433-0350
Enumeration DateFebruary 25, 2011
✔ NPI 1063719136 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in FL · 6906358
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Also ListedCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesTaxonomy 320900000X
1230 NW 5TH AVE, High Springs, FL 32643
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Other Identifiers 4

Medicaid691654696FL
Medicaid691654698FL
Other6906358FL · Adult Family Care Home Provider License Number
Medicaid691654603FL

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Raynyoda Jackson Med Wavier Agency LLC's NPI number?

The NPI number for Raynyoda Jackson Med Wavier Agency LLC is 1063719136. It was assigned to this organization in the NPPES registry on February 25, 2011.

Where is Raynyoda Jackson Med Wavier Agency LLC located?

Raynyoda Jackson Med Wavier Agency LLC is located at 1230 NW 5th Ave, High Springs, FL 32643. The listed phone number is (386) 433-0350.

What is Raynyoda Jackson Med Wavier Agency LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Raynyoda Jackson Med Wavier Agency LLC was last updated on February 25, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.