Provider Demographics
NPI:1558778779
Name:CHILDREN'S HOME SOCIETY OF FLORIDA
Entity Type:Organization
Organization Name:CHILDREN'S HOME SOCIETY OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT PROGRAM SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MERKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-794-0268
Mailing Address - Street 1:25 DELTONA BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 DELTONA BLVD STE 5
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4204
Practice Address - Country:US
Practice Address - Phone:904-794-0268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07-1582-000-05251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare