Healthcare Provider Details

I. General information

NPI: 1700159332
Provider Name (Legal Business Name): CHILDNET, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N. STATE RD. 7
PLANTATION FL
33317
US

IV. Provider business mailing address

313 N. STATE RD. 7
PLANTATION FL
33317
US

V. Phone/Fax

Practice location:
  • Phone: 954-414-6000
  • Fax: 954-414-6019
Mailing address:
  • Phone: 954-414-6000
  • Fax: 954-414-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. EMILIO BENITEZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 954-414-6000