Provider Demographics
NPI:1336582469
Name:COUNTRY ACRES CH
Entity Type:Organization
Organization Name:COUNTRY ACRES CH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:CBHT
Authorized Official - Phone:321-264-5000
Mailing Address - Street 1:1850 S DELEON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7733
Mailing Address - Country:US
Mailing Address - Phone:321-264-5000
Mailing Address - Fax:321-264-5195
Practice Address - Street 1:1850 S DELEON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7733
Practice Address - Country:US
Practice Address - Phone:321-264-5000
Practice Address - Fax:321-264-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility