Provider Demographics
NPI:1740579184
Name:TRAPEX FAMILY CENTER, INC.
Entity Type:Organization
Organization Name:TRAPEX FAMILY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRGIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-533-1165
Mailing Address - Street 1:4600 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3307
Mailing Address - Country:US
Mailing Address - Phone:954-533-1165
Mailing Address - Fax:954-533-1507
Practice Address - Street 1:4600 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE# 6
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-3307
Practice Address - Country:US
Practice Address - Phone:954-533-1165
Practice Address - Fax:954-533-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8645101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002890200Medicaid