Provider Demographics
NPI:1356946875
Name:FLORIDA JUSTICE CENTER, INC.
Entity type:Organization
Organization Name:FLORIDA JUSTICE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RARING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-758-7555
Mailing Address - Street 1:3469 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2872
Mailing Address - Country:US
Mailing Address - Phone:954-758-7555
Mailing Address - Fax:954-758-7556
Practice Address - Street 1:3469 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2872
Practice Address - Country:US
Practice Address - Phone:954-758-7555
Practice Address - Fax:954-758-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health