1447422928 NPI number — FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES

Table of content: (NPI 1447422928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447422928 NPI number — FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
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:
SOUTH FLORIDA STATE HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1447422928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 WINEWOOD BLVD
Provider Second Line Business Mailing Address:
BUILDING 6, ROOM 237
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32399-6570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-488-3250
Provider Business Mailing Address Fax Number:
850-487-1307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E CYPRESS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33025-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-392-3000
Provider Business Practice Location Address Fax Number:
954-392-3041
Provider Enumeration Date:
03/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NEVES
Authorized Official First Name:
JOY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF, SAMH CONTRACT MANAGEMENT
Authorized Official Telephone Number:
850-488-3250

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  4013 , 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: 026004500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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