Healthcare Provider Details

I. General information

NPI: 1952698805
Provider Name (Legal Business Name): G4S YOUTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8806 SW START CENTER ST
ARCADIA FL
34269-5914
US

IV. Provider business mailing address

8806 SW START CENTER ST
ARCADIA FL
34269-5914
US

V. Phone/Fax

Practice location:
  • Phone: 863-993-2600
  • Fax:
Mailing address:
  • Phone: 863-993-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES C HILL JR.
Title or Position: CEO
Credential:
Phone: 813-514-6275