Provider Demographics
NPI:1629340435
Name:CHILDREN'S HOME SCOCIETY
Entity Type:Organization
Organization Name:CHILDREN'S HOME SCOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NANOUCHEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEVELON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:561-305-5976
Mailing Address - Street 1:22319 SW 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-6010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1151
Practice Address - Country:US
Practice Address - Phone:954-453-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW5501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid