Provider Demographics
NPI:1629832282
Name:ADULT & CHILD MENTAL HEALTH CARE, LLC
Entity Type:Organization
Organization Name:ADULT & CHILD MENTAL HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-466-3200
Mailing Address - Street 1:4622 SUMMERDALE BLVD.
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571
Mailing Address - Country:US
Mailing Address - Phone:850-466-3200
Mailing Address - Fax:850-466-3203
Practice Address - Street 1:4622 SUMMERDALE BLVD.
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571
Practice Address - Country:US
Practice Address - Phone:850-466-3200
Practice Address - Fax:850-466-3203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADULT & CHILD MENTAL HEALTH CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008355300Medicaid