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General NPI Number Information
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NPI Number | 1235554783
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Entity Type | Organization
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Legal Business Name | FBCH LAND HOLDINGS II, INC.
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1015 SIKES BLVD.
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City | LAKELAND
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State | FL
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Zip | 33815
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Country | US
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Telephone | 863-687-8811
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Fax | 863-682-3157
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Provider Business Mailing Address
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Address Line | 1015 SIKES BLVD.
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City | LAKELAND
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State | FL
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Zip | 33815
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Country | US
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Telephone | 863-687-8811
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Fax | 863-682-3157
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT OPERATIONS
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Name | PAM WHITAKER
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Credential | PHD
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Telephone | 863-738-0966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 100035936
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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