Provider Demographics
NPI:1689348708
Name:BARNES HEALTHCARE OF FL LLC
Entity Type:Organization
Organization Name:BARNES HEALTHCARE OF FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:229-245-6001
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-1187
Mailing Address - Country:US
Mailing Address - Phone:122-924-5600
Mailing Address - Fax:
Practice Address - Street 1:2524 CATHAY CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4248
Practice Address - Country:US
Practice Address - Phone:850-894-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL677272200Medicaid