Provider Demographics
NPI:1619116373
Name:AMIKIDS BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:AMIKIDS BEHAVIORAL HEALTH, INC.
Other - Org Name:AMIKIDS CROSSROADS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT OF MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADSHAW HOPPOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-887-3300
Mailing Address - Street 1:5915 BENJAMIN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5239
Mailing Address - Country:US
Mailing Address - Phone:813-887-3300
Mailing Address - Fax:813-889-8092
Practice Address - Street 1:5915 BENJAMIN CENTER DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5239
Practice Address - Country:US
Practice Address - Phone:813-877-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMIKIDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-19
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000758900Medicaid