Provider Demographics
NPI:1194012252
Name:CHILDRENS HOME SOCIETY TREASURE COAST
Entity Type:Organization
Organization Name:CHILDRENS HOME SOCIETY TREASURE COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
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 1:590 NW PEACOCK BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2213
Practice Address - Country:US
Practice Address - Phone:772-344-4020
Practice Address - Fax:772-344-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health