Provider Demographics
NPI:1518960319
Name:FATHER FLANAGAN'S BOYS' HOME
Entity Type:Organization
Organization Name:FATHER FLANAGAN'S BOYS' HOME
Other - Org Name:FATHER FLANAGAN'S BOYS TOWN FLORIDA, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANGER OF BILLING AND A/C REC.
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HEMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-612-6049
Mailing Address - Street 1:1655 PALM BEACH LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2203
Mailing Address - Country:US
Mailing Address - Phone:561-612-6049
Mailing Address - Fax:561-366-4848
Practice Address - Street 1:1655 PALM BEACH LAKES BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2203
Practice Address - Country:US
Practice Address - Phone:561-612-6049
Practice Address - Fax:561-366-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL757704400Medicaid