Healthcare Provider Details

I. General information

NPI: 1609034909
Provider Name (Legal Business Name): G4S YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18500 SW 424TH ST
FLORIDA CITY FL
33034-7100
US

IV. Provider business mailing address

9609 GAYTON RD STE 100
RICHMOND VA
23238-4900
US

V. Phone/Fax

Practice location:
  • Phone: 305-247-6492
  • Fax: 305-247-1881
Mailing address:
  • Phone: 804-754-1100
  • Fax: 804-741-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number1113AD990301
License Number StateFL

VIII. Authorized Official

Name: BERNADETTE M SHAIA
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 804-754-1100