Provider Demographics
NPI:1528113339
Name:INSTITUTE FOR FAMILY CENTERED SERVICES
Entity type:Organization
Organization Name:INSTITUTE FOR FAMILY CENTERED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & SR ASST GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:RODENBERG-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-836-2234
Mailing Address - Street 1:3210 SKIPWITH RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4443
Mailing Address - Country:US
Mailing Address - Phone:804-346-0051
Mailing Address - Fax:804-346-0494
Practice Address - Street 1:2301 W SAMPLE RD
Practice Address - Street 2:BLDG 3 SUITE 4A
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3081
Practice Address - Country:US
Practice Address - Phone:954-977-9775
Practice Address - Fax:954-977-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070614100Medicaid