Healthcare Provider Details

I. General information

NPI: 1558590232
Provider Name (Legal Business Name): HIBISCUS CHILDREN'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 SW US HWY. 1 SUITE 400
PORT SAINT LUCIE FL
34952-1432
US

IV. Provider business mailing address

7410 SW US HWY. 1 SUITE 400
PORT SAINT LUCIE FL
34952-1432
US

V. Phone/Fax

Practice location:
  • Phone: 772-340-5044
  • Fax: 772-340-5916
Mailing address:
  • Phone: 772-340-5044
  • Fax: 772-340-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number03060136
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number03060136
License Number StateFL

VIII. Authorized Official

Name: KATHRYN M GARBOWSKI
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential: M.S.
Phone: 772-334-9311