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General NPI Number Information
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NPI Number | 1609034909
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Entity Type | Organization
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Legal Business Name | G4S YOUTH SERVICES
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 18500 SW 424TH ST
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City | FLORIDA CITY
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State | FL
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Zip | 33034-7100
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Country | US
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Telephone | 305-247-6492
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Fax | 305-247-1881
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Provider Business Mailing Address
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Address Line | 9609 GAYTON RD STE 100
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City | RICHMOND
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State | VA
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Zip | 23238-4900
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Country | US
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Telephone | 804-754-1100
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Fax | 804-741-9515
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Authorized Official
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Title or Position | ACCOUNTING MANAGER
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Name | BERNADETTE M SHAIA
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Credential |
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Telephone | 804-754-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 1113AD990301
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License Number State | FL
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