Provider Demographics
NPI:1184962847
Name:PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS
Entity type:Organization
Organization Name:PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-355-4753
Mailing Address - Street 1:810 DATURA ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5204
Mailing Address - Country:US
Mailing Address - Phone:561-355-4746
Mailing Address - Fax:561-355-3222
Practice Address - Street 1:3680 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4032
Practice Address - Country:US
Practice Address - Phone:561-355-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
FL251K00000X, 251S00000X, 253Z00000X, 261QC1500X, 261QM0801X, 332B00000X, 332U00000X, 333300000X
FL344261QA0600X
FL9082261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332U00000XSuppliersHome Delivered Meals
No333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6700732700Medicaid