Provider Demographics
NPI:1013219716
Name:FLORIDA SHERIFFS YOUTH RANCHES
Entity Type:Organization
Organization Name:FLORIDA SHERIFFS YOUTH RANCHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-842-5555
Mailing Address - Street 1:3180 ENTERPRISE RD E
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5205
Mailing Address - Country:US
Mailing Address - Phone:727-726-4761
Mailing Address - Fax:
Practice Address - Street 1:3180 ENTERPRISE RD E
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-5205
Practice Address - Country:US
Practice Address - Phone:727-726-4761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children