Provider Demographics
NPI:1306843859
Name:CDS FAMILY & BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CDS FAMILY & BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-244-0628
Mailing Address - Street 1:1218 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4245
Mailing Address - Country:US
Mailing Address - Phone:352-244-0628
Mailing Address - Fax:352-334-3817
Practice Address - Street 1:1218 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4245
Practice Address - Country:US
Practice Address - Phone:352-244-0628
Practice Address - Fax:352-334-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare