Provider Demographics
NPI:1013931765
Name:FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Other - Org Name:NORTHEAST FLORIDA STATE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-330-2001
Mailing Address - Street 1:7487 S STATE ROAD 121
Mailing Address - Street 2:ACCOUNTING DEPARTMENT
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-5480
Mailing Address - Country:US
Mailing Address - Phone:904-259-6211
Mailing Address - Fax:904-259-7154
Practice Address - Street 1:7487 S STATE ROAD 121
Practice Address - Street 2:ACCOUNTING DEPARTMENT
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-5451
Practice Address - Country:US
Practice Address - Phone:904-259-6211
Practice Address - Fax:904-259-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4004283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026002900Medicaid