Provider Demographics
NPI:1821058678
Name:BIG BEND CENTER FOR HUMAN SERVICE
Entity Type:Organization
Organization Name:BIG BEND CENTER FOR HUMAN SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMIONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-933-5018
Mailing Address - Street 1:PO BOX 4253
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32315-4253
Mailing Address - Country:US
Mailing Address - Phone:850-933-5018
Mailing Address - Fax:
Practice Address - Street 1:2109 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4307
Practice Address - Country:US
Practice Address - Phone:850-933-5018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare