Provider Demographics
NPI:1003885146
Name:FLORIDA SHERIFFS YOUTH RANCHES
Entity Type:Organization
Organization Name:FLORIDA SHERIFFS YOUTH RANCHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-842-5501
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:BOYS RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:32064
Mailing Address - Country:US
Mailing Address - Phone:386-842-5501
Mailing Address - Fax:386-842-2429
Practice Address - Street 1:2486 CECIL WEBB PL
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-8337
Practice Address - Country:US
Practice Address - Phone:386-842-5501
Practice Address - Fax:386-842-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility