Provider Demographics
NPI:1780327403
Name:FATHER FLANAGAN'S BOYS TOWN FLORIDA, INC
Entity type:Organization
Organization Name:FATHER FLANAGAN'S BOYS TOWN FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-612-6049
Mailing Address - Street 1:1655 PALM BEACH LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2203
Mailing Address - Country:US
Mailing Address - Phone:156-161-2604
Mailing Address - Fax:
Practice Address - Street 1:12983 SOUTHERN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9254
Practice Address - Country:US
Practice Address - Phone:561-612-6049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FATHER FLANAGAN'S BOYS TOWN FLORIDA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-20
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011708803Medicaid