MEDICARE: CHILDNET, 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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1245697606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDNET, INC.

Provider Business Mailing Address
First Line	:	1100 W MCNAB RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1116
Country	:	US
Telephone Number	:	954-414-6000
Fax Number	:	954-414-6010

Provider Business Practice Location Address
First Line	:	1100 W MCNAB RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1116
Country	:	US
Telephone Number	:	954-414-6000
Fax Number	:	954-414-6010

Authorized Official
Title or Position	:	PRESIDENT/CHIEF EXECUTIVE OFFICER
Name	:	MR. EMILIO BENITEZ
Credential	:
Telephone Number	:	954-414-6000

Provider Enumeration Date	:	01/15/2016
Last Update Date	:	01/15/2016

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