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General NPI Number Information
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NPI Number | 1508171463
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOME SOCITY OF FLORIDA
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 20162 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3832
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Country | US
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Telephone | 352-754-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 1485 S SEMORAN BLVD SUITE 1448
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City | WINTER PARK
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State | FL
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Zip | 32792-5533
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Country | US
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Telephone | 321-397-3000
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Fax |
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Authorized Official
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Title or Position | PROVIDER RELATIONS MANAGER
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Name | EILEEN TOSOLINI
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Credential |
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Telephone | 407-375-2565
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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 | 100005094
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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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