Provider Demographics
NPI:1083056402
Name:PICKETT FENCES FAMILY STABILIZATION AND MENTAL HEALTH SERVICES OF S. F
Entity Type:Organization
Organization Name:PICKETT FENCES FAMILY STABILIZATION AND MENTAL HEALTH SERVICES OF S. F
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:RUDEAN
Authorized Official - Last Name:ARLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:954-601-7338
Mailing Address - Street 1:4651 NW 6TH CT
Mailing Address - Street 2:C/O YORELL LASSITER
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1463
Mailing Address - Country:US
Mailing Address - Phone:954-601-7338
Mailing Address - Fax:
Practice Address - Street 1:4610 NW 9TH CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1437
Practice Address - Country:US
Practice Address - Phone:954-601-7338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management