MEDICARE: CHILDREN'S NETWORK SOUTHWEST FLORIDA, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407050214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S NETWORK SOUTHWEST FLORIDA, LLC

Provider Business Mailing Address
First Line	:	2232 ALTAMONT AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3561
Country	:	US
Telephone Number	:	239-226-1524
Fax Number	:	236-226-1511

Provider Business Practice Location Address
First Line	:	2180 W FIRST ST STE 400
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3217
Country	:	US
Telephone Number	:	239-226-1524
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DENNIS C ANDREWS
Credential	:
Telephone Number	:	239-226-1524

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	04/26/2019

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