MEDICARE: FAMILY PRESERVATION SERVICES

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	:	1972808871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRESERVATION SERVICES

Provider Business Mailing Address
First Line	:	11428 N 53RD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-2216
Country	:	US
Telephone Number	:	813-374-9416
Fax Number	:

Provider Business Practice Location Address
First Line	:	11428 N 53RD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-2216
Country	:	US
Telephone Number	:	813-374-9416
Fax Number	:

Authorized Official
Title or Position	:	CLINICIAN
Name	:	MISS JOY S SANTOS
Credential	:	M.S.
Telephone Number	:	813-451-1100

Provider Enumeration Date	:	01/24/2011
Last Update Date	:	01/24/2011

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Directions to “FAMILY PRESERVATION SERVICES ” Practice Location

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