Provider Demographics
NPI:1992019806
Name:HEART OF FLORIDA YOUTH RANCH
Entity type:Organization
Organization Name:HEART OF FLORIDA YOUTH RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-595-7100
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:15833 US 301 N
Mailing Address - City:CITRA
Mailing Address - State:FL
Mailing Address - Zip Code:32113-0336
Mailing Address - Country:US
Mailing Address - Phone:352-595-7100
Mailing Address - Fax:352-595-4135
Practice Address - Street 1:15833 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:CITRA
Practice Address - State:FL
Practice Address - Zip Code:32113-3155
Practice Address - Country:US
Practice Address - Phone:352-595-7100
Practice Address - Fax:352-595-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency