Healthcare Provider Details

I. General information

NPI: 1467611947
Provider Name (Legal Business Name): G4S YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 SOUTH BLVD
AVON PARK FL
33825-9200
US

IV. Provider business mailing address

242 SOUTH BLVD
AVON PARK FL
33825-9200
US

V. Phone/Fax

Practice location:
  • Phone: 863-452-3815
  • Fax:
Mailing address:
  • Phone:
  • 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: CARL PADGETT
Title or Position: BUSINESS MANAGER
Credential:
Phone: 863-452-3815