Provider Demographics
NPI:1962890376
Name:GO PLAY THERAPY CENTER, LLC
Entity type:Organization
Organization Name:GO PLAY THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-979-1222
Mailing Address - Street 1:66 COUNTY ROAD 100
Mailing Address - Street 2:
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971-5161
Mailing Address - Country:US
Mailing Address - Phone:265-979-1222
Mailing Address - Fax:256-979-1223
Practice Address - Street 1:2804 GREENHILL BLVD NW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3066
Practice Address - Country:US
Practice Address - Phone:256-979-1222
Practice Address - Fax:256-979-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty