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General NPI Number Information
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NPI Number | 1235277237
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Entity Type | Organization
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Legal Business Name | THE CHILDREN'S HOME, INC.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 10909 MEMORIAL HWY
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City | TAMPA
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State | FL
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Zip | 33615-2511
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Country | US
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Telephone | 813-855-4435
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Fax |
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Provider Business Mailing Address
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Address Line | 522 39TH AVE NE
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City | ST PETERSBURG
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State | FL
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Zip | 33703-5918
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Country | US
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Telephone | 727-822-6465
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Fax |
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Authorized Official
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Title or Position | COUNSELING SERVICES MANAGER
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Name | MRS. SANDNES SMITH BOULANGER
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Credential | MSW
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Telephone | 813-855-4435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | SW6638
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License Number State | FL
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