Provider Demographics
NPI:1245348879
Name:BOYS TOWN OF CENTRAL FLORIDA, INC.
Entity type:Organization
Organization Name:BOYS TOWN OF CENTRAL FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZBYLUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-366-3667
Mailing Address - Street 1:975 OKLAHOMA ST
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9104
Mailing Address - Country:US
Mailing Address - Phone:407-588-2170
Mailing Address - Fax:407-588-2171
Practice Address - Street 1:975 OKLAHOMA ST
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9104
Practice Address - Country:US
Practice Address - Phone:407-588-2170
Practice Address - Fax:407-588-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029959602Medicaid
FL029959602Medicaid