Provider Demographics
NPI:1417624511
Name:TYKES & TEENS, INC
Entity Type:Organization
Organization Name:TYKES & TEENS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZAYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-220-3439
Mailing Address - Street 1:3577 SW CORPORATE PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8153
Mailing Address - Country:US
Mailing Address - Phone:772-634-3232
Mailing Address - Fax:772-220-3484
Practice Address - Street 1:900 SE OCEAN BLVD STE 340
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3502
Practice Address - Country:US
Practice Address - Phone:772-220-3439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TYKES & TEENS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-26
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016912500Medicaid