Florida Palms Academy,Inc

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

44 Issued in FL

Legal business name

FLORIDA PALMS ACADEMY,INC

Practice address

5925 McKinley St
Hollywood, FL 33021-4560

Phone

(954) 963-0991

Fax

(954) 963-3956

NPI assigned

Jul 22, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David L Ferguson, PHD

Title

President

Phone

(954) 746-5200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Psychiatric residential treatment facility certification: CCN 10L001

Legal name

FLORIDA PALMS ACADEMY

Certification status

Active

Provider type (POS)

Psychiatric residential treatment facility

Participating since

Feb 26, 2009

Last certification

Mar 13, 2024

Beds

17

Ownership / control type

Government – state

Facility address

5925 McKinley Street
Hollywood, FL 33021

Locations

Networks

• HealthSun Health Plans Network

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shantelle Moxie, LCSW

  • Clinical Social Worker
  • Hollywood, FL
  • NPI 1275882896
  NPD (past)
• Brittany Noyola, LCSW

  • Clinical Social Worker
  • Hollywood, FL
  • NPI 1114574035
  NPD (past)
• Michelle Thomas, LCSW

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Hollywood, FL
  • NPI 1457373649

  Residential Treatment Facility, Emotionally Disturbed Children

  NPD (past)
• Stephanie Dawn Young-Azan, M.D.

  • Child & Adolescent Psychiatry Physician
  • Sunrise, FL
  • NPI 1073730800
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374451200000",
    "number": "1104268085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 W OAKLAND PARK BLVD",
            "address_2": "STE 200",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333516925",
            "telephone_number": "954-746-5200",
            "fax_number": "954-746-5216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5925 MCKINLEY ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330214560",
            "telephone_number": "954-963-0991",
            "fax_number": "954-963-3956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA PALMS ACADEMY,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-22",
        "last_updated": "2013-07-22",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-746-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "FL",
            "license": "44",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029582516",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.