Provider Demographics
NPI:1558378679
Name:PARENT-CHILD CENTER
Entity Type:Organization
Organization Name:PARENT-CHILD CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:G SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-841-3500
Mailing Address - Street 1:2001 W BLUE HERON BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-5003
Mailing Address - Country:US
Mailing Address - Phone:561-841-3500
Mailing Address - Fax:561-841-3555
Practice Address - Street 1:2001 W BLUE HERON BLVD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404
Practice Address - Country:US
Practice Address - Phone:561-841-3500
Practice Address - Fax:561-841-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11926101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060336800Medicaid