Provider Demographics
NPI:1760608723
Name:PEDIATRIC ALTERNATIVE TREATMENT CARE HOUSING AND EVALUATION SERVICES
Entity Type:Organization
Organization Name:PEDIATRIC ALTERNATIVE TREATMENT CARE HOUSING AND EVALUATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZONA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-242-8122
Mailing Address - Street 1:335 S KROME AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-4906
Mailing Address - Country:US
Mailing Address - Phone:305-242-8122
Mailing Address - Fax:305-242-8837
Practice Address - Street 1:335 S KROME AVE
Practice Address - Street 2:SUITE 104-107
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-4906
Practice Address - Country:US
Practice Address - Phone:305-242-8122
Practice Address - Fax:305-242-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8918619 00Medicaid