Provider Demographics
NPI:1760486427
Name:BROOKWOOD FLORIDA - CENTRAL, INC
Entity Type:Organization
Organization Name:BROOKWOOD FLORIDA - CENTRAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANETTE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MONJE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-822-4789
Mailing Address - Street 1:901 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1901
Mailing Address - Country:US
Mailing Address - Phone:727-822-4789
Mailing Address - Fax:727-896-4475
Practice Address - Street 1:901 7TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1901
Practice Address - Country:US
Practice Address - Phone:727-822-4789
Practice Address - Fax:727-896-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0405-002-052320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness