Provider Demographics
NPI:1740432806
Name:BROOKWOOD FLORIDA - SOUTH, INC
Entity type:Organization
Organization Name:BROOKWOOD FLORIDA - SOUTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANETTE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MONJE
Authorized Official - Suffix:
Authorized Official - Credentials:MH7929
Authorized Official - Phone:727-822-4789
Mailing Address - Street 1:253 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:N FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-3759
Mailing Address - Country:US
Mailing Address - Phone:239-652-0354
Mailing Address - Fax:
Practice Address - Street 1:253 ROSE ST
Practice Address - Street 2:
Practice Address - City:N FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3759
Practice Address - Country:US
Practice Address - Phone:239-652-0354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKWOOD FLORIDA - CENTRAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health