Provider Demographics
NPI:1912480096
Name:CHILDRENS ADVANCE CENTER INC
Entity Type:Organization
Organization Name:CHILDRENS ADVANCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YALILI
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZO SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-451-0032
Mailing Address - Street 1:9025 CAMINO VILLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-1064
Mailing Address - Country:US
Mailing Address - Phone:813-451-0032
Mailing Address - Fax:813-898-0015
Practice Address - Street 1:9025 CAMINO VILLA BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-1064
Practice Address - Country:US
Practice Address - Phone:813-451-0032
Practice Address - Fax:813-898-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty