Provider Demographics
NPI:1376111534
Name:APALACHEE CENTER INC.
Entity Type:Organization
Organization Name:APALACHEE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAT TEAM
Authorized Official - Prefix:MS
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:STICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-973-5124
Mailing Address - Street 1:225 SW SUMATRA AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-1454
Mailing Address - Country:US
Mailing Address - Phone:850-973-5124
Mailing Address - Fax:850-973-5128
Practice Address - Street 1:225 SW SUMATRA AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-1454
Practice Address - Country:US
Practice Address - Phone:850-973-5124
Practice Address - Fax:850-973-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXXXMedicaid
FL20962Medicaid