Provider Demographics
NPI:1396884607
Name:THE FLORIDA CENTER FOR CHILD AND FAMILY DEVELOPMENT
Entity type:Organization
Organization Name:THE FLORIDA CENTER FOR CHILD AND FAMILY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGEMENT SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHAUFELE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:941-371-4799
Mailing Address - Street 1:4610 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 INDEPENDENCE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2171
Practice Address - Country:US
Practice Address - Phone:941-371-4799
Practice Address - Fax:941-371-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7594321Medicaid