Healthcare Provider Details

I. General information

NPI: 1053555748
Provider Name (Legal Business Name): G4S YOUTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 HIGHWAY 441 N
OKEECHOBEE FL
34972-8637
US

IV. Provider business mailing address

4200 WACKENHUT DR
WEST PALM BEACH FL
33410-4242
US

V. Phone/Fax

Practice location:
  • Phone: 863-357-0047
  • Fax: 863-357-0368
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: MR. KERRY LAWRENCE KNOTT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 561-691-6729