Provider Demographics
NPI:1831748706
Name:THE NATIONAL CENTER FOR LIFE AND LIBERTY
Entity type:Organization
Organization Name:THE NATIONAL CENTER FOR LIFE AND LIBERTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-410-6409
Mailing Address - Street 1:PO BOX 5076
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779-5076
Mailing Address - Country:US
Mailing Address - Phone:888-233-6255
Mailing Address - Fax:
Practice Address - Street 1:13702 GREEN ISLE TER
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8426
Practice Address - Country:US
Practice Address - Phone:888-233-6255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children