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NPI Code Detail

MEDICARE: CROSSWINDS YOUTH SERVICES, INC.

MEDICARE: CROSSWINDS YOUTH SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency0705AD694301FL

General Provider Information

NPI Number : 1245404375
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROSSWINDS YOUTH SERVICES, INC.
Provider Business Mailing Address
First Line : 1407 DIXON BLVD
Second Line :
City : COCOA
State : FL
Zip : 32922-6411
Country : US
Telephone Number : 321-452-0800
Fax Number : 321-394-0385
Provider Business Practice Location Address
First Line : 1407 DIXON BLVD
Second Line :
City : COCOA
State : FL
Zip : 32922-6411
Country : US
Telephone Number : 321-452-0800
Fax Number : 321-394-0385
Authorized Official
Title or Position : DIRECTOR OF PROGRAMS
Name : MS. KAREN LOCKE
Credential : MPA
Telephone Number : 321-452-0800
Provider Enumeration Date : 04/18/2008
Last Update Date : 04/18/2008

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1568740785 — MRS. LARA PENNEY CHICONE
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1639426430 — MS. SHARON R SANQUIST
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Directions to “CROSSWINDS YOUTH SERVICES, INC. ” Practice Location

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