Provider Demographics
NPI:1407050214
Name:CHILDREN'S NETWORK SOUTHWEST FLORIDA, LLC
Entity Type:Organization
Organization Name:CHILDREN'S NETWORK SOUTHWEST FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-226-1524
Mailing Address - Street 1:2232 ALTAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3561
Mailing Address - Country:US
Mailing Address - Phone:239-226-1524
Mailing Address - Fax:236-226-1511
Practice Address - Street 1:2180 W FIRST ST STE 400
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3217
Practice Address - Country:US
Practice Address - Phone:239-226-1524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health