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General NPI Number Information
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NPI Number | 1538449681
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Entity Type | Organization
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Legal Business Name | CHILDRENS HOME SOCIETY OF FL
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 4520 SELVITZ RD
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City | FORT PIERCE
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State | FL
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Zip | 34981-4801
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Country | US
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Telephone | 772-460-9752
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Fax |
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Provider Business Mailing Address
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Address Line | 4520 SELVITZ RD
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City | FORT PIERCE
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State | FL
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Zip | 34981-4801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL SUPERVISER
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Name | RESHANNA WILLIAMS
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Credential |
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Telephone | 772-460-9752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 59-019243
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License Number State | FL
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