MEDICARE: HIBISCUS CHILDRENS CENTER

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1356646921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIBISCUS CHILDRENS CENTER

Provider Business Mailing Address
First Line	:	5091 E PORTOFINO LANDINGS BLVD
Second Line	:	UNIT 201
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-5444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5091 E PORTOFINO LANDINGS BLVD
Second Line	:	UNIT 201
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-5444
Country	:	US
Telephone Number	:	772-882-4074
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	CHERON BUTLER
Credential	:	MA
Telephone Number	:	772-882-4074

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	01/12/2011

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