Provider Demographics
NPI:1437143054
Name:THE CHILDREN'S PLACE AT HOME SAFE, INC.
Entity Type:Organization
Organization Name:THE CHILDREN'S PLACE AT HOME SAFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LADIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-383-9800
Mailing Address - Street 1:2840 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4729
Mailing Address - Country:US
Mailing Address - Phone:561-383-9800
Mailing Address - Fax:561-383-9854
Practice Address - Street 1:2840 6TH AVE S
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4729
Practice Address - Country:US
Practice Address - Phone:561-383-9800
Practice Address - Fax:561-383-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070522502Medicaid
FL070522504Medicaid
FL070522501Medicaid
FL070795300Medicaid
FL070522500Medicaid
FL070522503Medicaid
FL912205200Medicaid