=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336482181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDS FIRST, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2013
-----------------------------------------------------
Last Update Date | 03/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2499 GLADES RD SUITE 305B
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-7209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-756-3477
-----------------------------------------------------
Fax | 561-488-4003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3118 PALM DR
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33483-6215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-756-3477
-----------------------------------------------------
Fax | 561-488-4003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROXANNE LYN GROBBEL
-----------------------------------------------------
Credential | JD, LCSW
-----------------------------------------------------
Telephone | 561-756-3477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | SW8627
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------