Provider Demographics
NPI:1104068352
Name:ELIZABETH H. FAULK FOUNDATION, INC.
Entity type:Organization
Organization Name:ELIZABETH H. FAULK FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAMS AND TRAINING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-483-5300
Mailing Address - Street 1:22455 BOCA RIO RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4708
Mailing Address - Country:US
Mailing Address - Phone:561-483-5300
Mailing Address - Fax:561-483-5325
Practice Address - Street 1:22455 BOCA RIO RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-4708
Practice Address - Country:US
Practice Address - Phone:561-483-5300
Practice Address - Fax:561-483-5325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health