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General NPI Number Information
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NPI Number | 1487986238
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Entity Type | Organization
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Legal Business Name | G4S YOUTH SERVICES, LLC
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 2953 WILSON RD
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City | LAND O LAKES
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State | FL
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Zip | 34638-4364
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Country | US
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Telephone | 813-514-6541
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Fax | 813-514-6723
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Provider Business Mailing Address
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Address Line | 4200 WACKENHUT DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33410-4242
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Country | US
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Telephone | 561-691-6610
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Fax | 561-691-6578
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KERRY KNOTT
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Credential |
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Telephone | 561-691-6729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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