Provider Demographics
NPI:1891105573
Name:BACOT ACADEMY
Entity Type:Organization
Organization Name:BACOT ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:KIMBRELL
Authorized Official - Last Name:BACOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-215-2614
Mailing Address - Street 1:3704 W 23RD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-1371
Mailing Address - Country:US
Mailing Address - Phone:850-215-2614
Mailing Address - Fax:
Practice Address - Street 1:3704 W 23RD ST
Practice Address - Street 2:SUITE D
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-1371
Practice Address - Country:US
Practice Address - Phone:850-215-2614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health