Provider Demographics
NPI:1114229994
Name:C.Y.B. INC
Entity Type:Organization
Organization Name:C.Y.B. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MALISHAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MINCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-928-1424
Mailing Address - Street 1:525 E GOTTSCHE AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3607
Mailing Address - Country:US
Mailing Address - Phone:352-357-3625
Mailing Address - Fax:
Practice Address - Street 1:525 E GOTTSCHE AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3607
Practice Address - Country:US
Practice Address - Phone:352-357-3625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL688505596320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688505596OtherPROVIDER NUMBER