Provider Demographics
NPI:1164707329
Name:CHILDRENS HOME SOCIETY
Entity Type:Organization
Organization Name:CHILDRENS HOME SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-397-3000
Mailing Address - Street 1:1485 S SEMORAN BLVD
Mailing Address - Street 2:SUITE 1448
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5533
Mailing Address - Country:US
Mailing Address - Phone:321-397-3000
Mailing Address - Fax:321-397-3016
Practice Address - Street 1:405 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-1870
Practice Address - Country:US
Practice Address - Phone:352-334-0956
Practice Address - Fax:352-334-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070971900Medicaid