Provider Demographics
NPI:1881149482
Name:FORTY CARROTS FAMILY CENTER
Entity type:Organization
Organization Name:FORTY CARROTS FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-365-7716
Mailing Address - Street 1:1426 S TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2605
Mailing Address - Country:US
Mailing Address - Phone:941-365-7716
Mailing Address - Fax:
Practice Address - Street 1:1426 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2605
Practice Address - Country:US
Practice Address - Phone:941-365-7716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health