Provider Demographics
NPI: | 1275865024 |
---|---|
Name: | G4S YOUTH SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | G4S YOUTH SERVICES, LLC |
Other - Org Name: | OKEECHOBEE GIRLS ACADEMY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KERRY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KNOTT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 561-691-6729 |
Mailing Address - Street 1: | 4200 WACKENHUT DR |
Mailing Address - Street 2: | |
Mailing Address - City: | WEST PALM BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33410-4242 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-691-6610 |
Mailing Address - Fax: | 561-691-6578 |
Practice Address - Street 1: | 1117 NE 39TH BLVD |
Practice Address - Street 2: | |
Practice Address - City: | OKEECHOBEE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34972-8629 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-691-6610 |
Practice Address - Fax: | 561-691-6578 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-02-04 |
Last Update Date: | 2010-02-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Single Specialty |