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General NPI Number Information
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NPI Number | 1437143054
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Entity Type | Organization
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Legal Business Name | THE CHILDREN'S PLACE AT HOME SAFE, INC.
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 2840 6TH AVE S
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City | LAKE WORTH
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State | FL
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Zip | 33461-4729
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Country | US
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Telephone | 561-383-9800
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Fax | 561-383-9854
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Provider Business Mailing Address
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Address Line | 2840 6TH AVE S
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City | LAKE WORTH
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State | FL
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Zip | 33461-4729
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Country | US
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Telephone | 561-383-9800
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Fax | 561-383-9854
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Authorized Official
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Title or Position | CHEIF EXECUTIVE OFFICER
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Name | MR. MATTHEW LADIKA
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Credential |
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Telephone | 561-383-9800
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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 |
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License Number State |
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