Provider Demographics
NPI:1316991243
Name:FLORIDA SHERIFFS YOUTH RANCHS INC.
Entity type:Organization
Organization Name:FLORIDA SHERIFFS YOUTH RANCHS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-842-5501
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-1550
Mailing Address - Country:US
Mailing Address - Phone:386-842-5501
Mailing Address - Fax:386-842-2429
Practice Address - Street 1:3350 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-8471
Practice Address - Country:US
Practice Address - Phone:863-533-0371
Practice Address - Fax:863-533-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL360009208Medicaid