Provider Demographics
NPI:1043520653
Name:G4S YOUTH SERVICES, LLC
Entity type:Organization
Organization Name:G4S YOUTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-691-6729
Mailing Address - Street 1:4200 WACKENHUT DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4242
Mailing Address - Country:US
Mailing Address - Phone:561-691-6610
Mailing Address - Fax:561-691-6578
Practice Address - Street 1:2145 BOB PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6700
Practice Address - Country:US
Practice Address - Phone:863-519-5581
Practice Address - Fax:863-519-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0707546Medicaid