Basic Information
| Provider Information | |||||||||
| NPI: | 1609045434 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY SERVICE CENTERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2960 ROOSEVELT BLVD | ||||||||
| Address2: | ADMIN. BUILDING | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337601952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275310482 | ||||||||
| FaxNumber: | 7275367867 | ||||||||
| Practice Location | |||||||||
| Address1: | 2960 ROOSEVELT BLVD | ||||||||
| Address2: | ADMIN. BUILDING | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337601952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275310482 | ||||||||
| FaxNumber: | 7275367867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2008 | ||||||||
| LastUpdateDate: | 11/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | BARNES | ||||||||
| AuthorizedOfficialFirstName: | SERENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 7274895243 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | BS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | HCC5519 | FL | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 024077001 | 05 | FL | MEDICAID |