Organization
THE CHILDREN'S PLACE AT HOME SAFE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW LADIKA (CHEIF EXECUTIVE OFFICER)
(561) 383-9800
Entity
Organization
Contact information
Practice address
2840 6TH AVE S, LAKE WORTH, FL 33461-4729
(561) 383-9800
(561) 383-9854
Mailing address
2840 6TH AVE S, LAKE WORTH, FL 33461-4729
(561) 383-9800
(561) 383-9854
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070522500
—
FL
05
—
070522501
—
FL
05
—
070522502
—
FL
05
—
070522503
—
FL
05
—
070522504
—
FL
05
—
070795300
—
FL
05
—
912205200
—
FL
Enumeration date
09/09/2005
Last updated
07/18/2008
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