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General NPI Number Information
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NPI Number | 1407050214
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Entity Type | Organization
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Legal Business Name | CHILDREN'S NETWORK SOUTHWEST FLORIDA, LLC
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 2180 W FIRST ST STE 400
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City | FORT MYERS
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State | FL
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Zip | 33901-3217
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Country | US
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Telephone | 239-226-1524
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Fax |
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Provider Business Mailing Address
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Address Line | 2232 ALTAMONT AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-3561
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Country | US
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Telephone | 239-226-1524
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Fax | 236-226-1511
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Authorized Official
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Title or Position | CFO
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Name | DENNIS C ANDREWS
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Credential |
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Telephone | 239-226-1524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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