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General NPI Number Information
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NPI Number | 1518341924
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Entity Type | Organization
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Legal Business Name | BROOKWOOD FLORIDA, INC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 901 7TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33705-1901
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Country | US
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Telephone | 727-822-4789
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Fax |
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Provider Business Mailing Address
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Address Line | 901 7TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33705-1901
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Country | US
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Telephone | 727-822-4789
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. PAMELA J MESMER
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Credential | PHD, LMHC
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Telephone | 727-822-4789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MH2991
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License Number State | FL
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