Provider Demographics
NPI:1710150834
Name:LA AMISTAD FOUNDATION, INC.
Entity Type:Organization
Organization Name:LA AMISTAD FOUNDATION, INC.
Other - Org Name:LAKEWOOD CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-332-1711
Mailing Address - Street 1:8400 LA AMISTAD CV
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2900
Mailing Address - Country:US
Mailing Address - Phone:407-332-1711
Mailing Address - Fax:407-331-7291
Practice Address - Street 1:8400 LA AMISTAD CV
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2900
Practice Address - Country:US
Practice Address - Phone:407-332-1711
Practice Address - Fax:407-331-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8569323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility