Provider Demographics
NPI:1821213786
Name:MAINSL FLORIDA INC.
Entity Type:Organization
Organization Name:MAINSL FLORIDA INC.
Other - Org Name:MAINSL SERVICES INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-416-9108
Mailing Address - Street 1:6100 HOLLYWOOD BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7981
Mailing Address - Country:US
Mailing Address - Phone:954-919-0321
Mailing Address - Fax:954-919-0324
Practice Address - Street 1:6100 HOLLYWOOD BLVD STE 211
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7981
Practice Address - Country:US
Practice Address - Phone:954-919-0321
Practice Address - Fax:954-919-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2262270320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities