Healthcare Provider Details

I. General information

NPI: 1104268085
Provider Name (Legal Business Name): FLORIDA PALMS ACADEMY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 MCKINLEY ST
HOLLYWOOD FL
33021-4560
US

IV. Provider business mailing address

10001 W OAKLAND PARK BLVD STE 200
SUNRISE FL
33351-6925
US

V. Phone/Fax

Practice location:
  • Phone: 954-963-0991
  • Fax: 954-963-3956
Mailing address:
  • Phone: 954-746-5200
  • Fax: 954-746-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number44
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID L FERGUSON
Title or Position: PRESIDENT
Credential: PHD
Phone: 954-746-5200