| NPI | 1245440874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN JIMENEZ YANDEK Director Credentialing/Billing 727-430-3291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: FL 8618) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-02-18 |