Healthcare Provider Details

I. General information

NPI: 1003896606
Provider Name (Legal Business Name): THE CHILDREN'S HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10909 MEMORIAL HWY
TAMPA FL
33615-2511
US

IV. Provider business mailing address

10909 MEMORIAL HWY
TAMPA FL
33615-2511
US

V. Phone/Fax

Practice location:
  • Phone: 813-855-4435
  • Fax: 813-855-8640
Mailing address:
  • Phone: 813-855-4435
  • Fax: 813-855-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: IRENE K RICKUS
Title or Position: PRESIDENT & CEO
Credential:
Phone: 813-864-1501