Healthcare Provider Details

I. General information

NPI: 1750487955
Provider Name (Legal Business Name): CHILDREN'S HOME SOCIETY OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 DIXON BLVD
COCOA FL
32922-6471
US

IV. Provider business mailing address

5768 S SEMORAN BLVD
ORLANDO FL
32822-4818
US

V. Phone/Fax

Practice location:
  • Phone: 321-752-3170
  • Fax:
Mailing address:
  • Phone: 321-397-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier750450102
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name: MRS. ANDRY SWEET
Title or Position: CEO
Credential:
Phone: 321-397-3000