Healthcare Provider Details

I. General information

NPI: 1235277237
Provider Name (Legal Business Name): THE CHILDREN'S HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10909 MEMORIAL HWY
TAMPA FL
33615-2511
US

IV. Provider business mailing address

522 39TH AVE NE
ST PETERSBURG FL
33703-5918
US

V. Phone/Fax

Practice location:
  • Phone: 813-855-4435
  • Fax:
Mailing address:
  • Phone: 727-822-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberSW6638
License Number StateFL

VIII. Authorized Official

Name: MRS. SANDNES SMITH BOULANGER
Title or Position: COUNSELING SERVICES MANAGER
Credential: MSW
Phone: 813-855-4435