Healthcare Provider Details

I. General information

NPI: 1316991243
Provider Name (Legal Business Name): FLORIDA SHERIFFS YOUTH RANCHS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 STATE ROAD 60 E
BARTOW FL
33830-8471
US

IV. Provider business mailing address

PO BOX 2000
LIVE OAK FL
32064-1550
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-0371
  • Fax: 863-533-7006
Mailing address:
  • Phone: 386-842-5501
  • Fax: 386-842-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOANNE E THOMAS
Title or Position: PRESIDENT
Credential:
Phone: 386-842-5501