Provider Demographics
NPI: | 1851471213 |
---|---|
Name: | CHILDREN'S HOME SOCIETY OF FLORIDA |
Entity Type: | Organization |
Organization Name: | CHILDREN'S HOME SOCIETY OF FLORIDA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PROVIDER RELATIONS MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EILEEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TOSOLINI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 321-397-5251 |
Mailing Address - Street 1: | 5766 S SEMORAN BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | ORLANDO |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32822-4818 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 321-397-3000 |
Mailing Address - Fax: | 321-397-3016 |
Practice Address - Street 1: | 2210 TALL PINES DR STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | LARGO |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33771-5347 |
Practice Address - Country: | US |
Practice Address - Phone: | 727-953-3354 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-10-17 |
Last Update Date: | 2021-08-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 360030100 | Medicaid |