Healthcare Provider Details

I. General information

NPI: 1740550359
Provider Name (Legal Business Name): G4S YOUTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 BENJAMIN RD SUITE 400
TAMPA FL
33634-5116
US

IV. Provider business mailing address

6302 BENJAMIN RD SUITE 400
TAMPA FL
33634-5116
US

V. Phone/Fax

Practice location:
  • Phone: 813-514-6275
  • Fax: 813-514-6723
Mailing address:
  • Phone: 813-514-6275
  • Fax: 813-514-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES C HILL JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 813-514-6275