1942531900 NPI number — HIBISCUS CHILDREN'S CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942531900 NPI number — HIBISCUS CHILDREN'S CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIBISCUS CHILDREN'S CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942531900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 NE DIXIE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JENSEN BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34957-5949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-334-9311
Provider Business Mailing Address Fax Number:
772-334-1991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 SW PARK ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
OKEECHOBEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34972-4173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-340-5044
Provider Business Practice Location Address Fax Number:
772-340-5916
Provider Enumeration Date:
01/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GARBOWSKI
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
772-334-9311

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  03060136 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 03060136 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 070709106 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 070709107 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com