Healthcare Provider Details

I. General information

NPI: 1487986238
Provider Name (Legal Business Name): G4S YOUTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2953 WILSON RD
LAND O LAKES FL
34638-4364
US

IV. Provider business mailing address

4200 WACKENHUT DR
WEST PALM BEACH FL
33410-4242
US

V. Phone/Fax

Practice location:
  • Phone: 813-514-6541
  • Fax: 813-514-6723
Mailing address:
  • Phone: 561-691-6610
  • Fax: 561-691-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: KERRY KNOTT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 561-691-6729