Healthcare Provider Details

I. General information

NPI: 1730806233
Provider Name (Legal Business Name): CHILDRENS CARING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12811 KENWOOD LN STE 113
FORT MYERS FL
33907-5645
US

IV. Provider business mailing address

2407 CASLOTTI WAY
CAPE CORAL FL
33909-5276
US

V. Phone/Fax

Practice location:
  • Phone: 786-296-5106
  • Fax:
Mailing address:
  • Phone: 786-296-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GINA MANRIQUE
Title or Position: VICE PRESIDENT
Credential:
Phone: 786-296-5106