Healthcare Provider Details

I. General information

NPI: 1790725406
Provider Name (Legal Business Name): YOUTH AND FAMILY CENTERED SERVICES OF FL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12012 BOYETTE ROAD
RIVERVIEW FL
33569-5631
US

IV. Provider business mailing address

12012 BOYETTE ROAD
RIVERVIEW FL
33569-5631
US

V. Phone/Fax

Practice location:
  • Phone: 813-677-6700
  • Fax: 813-671-3145
Mailing address:
  • Phone: 813-677-6700
  • Fax: 813-671-3145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number0605-39
License Number StateFL

VIII. Authorized Official

Name: MS. ANA M GENNE
Title or Position: CFO
Credential:
Phone: 813-677-6700