Provider Demographics
NPI:1295805703
Name:CHILDREN'S HARBOR
Entity type:Organization
Organization Name:CHILDREN'S HARBOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:954-392-5689
Mailing Address - Street 1:19425 SW 58TH MNR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3338
Mailing Address - Country:US
Mailing Address - Phone:954-392-5689
Mailing Address - Fax:954-252-7134
Practice Address - Street 1:19425 SW 58TH MNR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-3338
Practice Address - Country:US
Practice Address - Phone:954-392-5689
Practice Address - Fax:954-252-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health