Provider Demographics
NPI:1588154637
Name:SECOND START FLORIDA LLC
Entity type:Organization
Organization Name:SECOND START FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY MANAGEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-423-9062
Mailing Address - Street 1:9815 MEADOW FIELD CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5104
Mailing Address - Country:US
Mailing Address - Phone:919-423-9062
Mailing Address - Fax:
Practice Address - Street 1:9815 MEADOW FIELD CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5104
Practice Address - Country:US
Practice Address - Phone:919-423-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health