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General NPI Number Information
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NPI Number | 1821213786
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Entity Type | Organization
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Legal Business Name | MAINSL FLORIDA INC.
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6100 HOLLYWOOD BLVD STE 211
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City | HOLLYWOOD
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State | FL
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Zip | 33024-7981
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Country | US
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Telephone | 954-919-0321
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Fax | 954-919-0324
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Provider Business Mailing Address
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Address Line | 6100 HOLLYWOOD BLVD STE 211
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City | HOLLYWOOD
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State | FL
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Zip | 33024-7981
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Country | US
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Telephone | 954-919-0321
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Fax | 954-919-0324
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DONNA OLSON
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Credential |
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Telephone | 763-416-9108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 2262270
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License Number State | FL
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