Healthcare Provider Details

I. General information

NPI: 1245241165
Provider Name (Legal Business Name): HILLSBOROUGH COUNTY DEPT OF CHILDREN'S SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CLAY MANGUM LN
TAMPA FL
33618-2501
US

IV. Provider business mailing address

3110 CLAY MANGUM LN
TAMPA FL
33618-2501
US

V. Phone/Fax

Practice location:
  • Phone: 813-264-3807
  • Fax: 813-264-3872
Mailing address:
  • Phone: 813-264-3807
  • Fax: 813-264-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number8006-24
License Number StateFL

VIII. Authorized Official

Name: DR. CHARLES D. FURMAN III
Title or Position: CLINICAL SERVICES DIRECTOR
Credential: PSY.D.
Phone: 813-264-3807