Santa Rosa Youth Academy

LBN: Santa Rosa Youth Academy
Santa Rosa Youth Academy is an health care organization with primary practice located at 12364 Environmental Center Rd , Holt FL 32564-9126. The organization recently has 2 registered licenses in different health care specialties including Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children, Residential Treatment Facilities / Substance Abuse Treatment, Children. Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children is the primary health care specialty. Santa Rosa Youth Academy can be contacted via phone (850) 957-3600, or through Moody, Michelle via phone (850) 957-3600.

Contact Information

Primary practice address
12364 Environmental Center Rd Holt FL 32564-9126
Phone: (850) 957-3600
Fax: (850) 957-9000
Website:
Map and Directions
Authorized official contact:
Name: Moody, Michelle Licensed Clinical Social Worker (LCSW)
Phone: (850) 957-3600

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children 322D00000X
Residential Treatment Facilities / Substance Abuse Treatment, Children 3245S0500X 0157AD569002 Florida

Profile Details

NPI number 1568678514
LBN Legal business name Santa Rosa Youth Academy
DBA Doing business as
Authorized official Moody, Michelle Licensed Clinical Social Worker (LCSW)
Entity Organization
Organization subpart 1 Yes
Enumeration date May 15th, 2007
Last updated Jul 14th, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568678514 NPPES
Florida MEDICAID 7684541
Florida MEDICAID 070956502

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