MEDICARE: HIBISCUS CHILDREN'S 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1699043539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIBISCUS CHILDREN'S CENTER

Provider Business Mailing Address
First Line	:	664 SW 35TH STREET APT 4
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990
Country	:	US
Telephone Number	:	561-449-5483
Fax Number	:

Provider Business Practice Location Address
First Line	:	664 SW 35TH ST APT 4
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-3659
Country	:	US
Telephone Number	:	561-449-5483
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	SABRINA LOVELY NOTTINGHAM
Credential	:
Telephone Number	:	561-449-5483

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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