Provider Demographics
NPI:1952303737
Name:THE HENRY & RILLA WHITE YOUTH FOUNDATION INC
Entity Type:Organization
Organization Name:THE HENRY & RILLA WHITE YOUTH FOUNDATION INC
Other - Org Name:HENRY & RILLA WHITE FOUNDATION INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-922-8375
Mailing Address - Street 1:2833 REMINGTON GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-3752
Mailing Address - Country:US
Mailing Address - Phone:850-922-8375
Mailing Address - Fax:850-488-2071
Practice Address - Street 1:305 NW CHRISTIAN CT
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4837
Practice Address - Country:US
Practice Address - Phone:352-752-7813
Practice Address - Fax:352-752-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055048511Medicaid
FL055048504Medicaid
FL055048507Medicaid
FL055048508Medicaid
FL055048517Medicaid
FL055048521Medicaid
FL055048502Medicaid
FL055048518Medicaid
FL055048505Medicaid
FL055048506Medicaid
FL055048514Medicaid
FL055048522Medicaid
FL055048501Medicaid
FL055048516Medicaid
FL055048500Medicaid
FL055048515Medicaid
FL076660700Medicaid