Healthcare Provider Details

I. General information

NPI: 1992801435
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 SAN DIEGO RD
JACKSONVILLE FL
32207-3691
US

IV. Provider business mailing address

1485 S SEMORAN BLVD SUITE 1448
WINTER PARK FL
32792-5533
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-7744
  • Fax: 904-348-2818
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID BUNDY
Title or Position: CEO
Credential:
Phone: 321-397-3000