Provider Demographics
NPI:1588612857
Name:FLORIDA HOME BOUND MENTAL HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:FLORIDA HOME BOUND MENTAL HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BIGGS-OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:305-892-7272
Mailing Address - Street 1:1400 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6034
Mailing Address - Country:US
Mailing Address - Phone:305-892-7272
Mailing Address - Fax:305-892-2554
Practice Address - Street 1:1400 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6034
Practice Address - Country:US
Practice Address - Phone:305-892-7272
Practice Address - Fax:305-892-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991076251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650965700Medicaid
FL650965700Medicaid