NPIMap

Organization Active NPI

G4S Youth Services, LLC

Doing business as Polk Halfway House

  • Community/Behavioral Health Agency
  • Bartow, FL
National Provider Identifier
1356659288
Registry record updated Sep 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
070754502 Issued in FL
Legal business name
G4S YOUTH SERVICES, LLC
Doing business as
Polk Halfway House
Practice address
2145 Bob Phillips Rd
Bartow, FL 33830-6700
Phone
(863) 519-5581
Fax
(863) 519-6603
NPI assigned
Sep 14, 2010
Last updated
Sep 14, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2010

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

Authorized official

Name
Mr. Kerry L. Knott
Title
Chief Executive Officer
Phone
(561) 691-6729

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 070754502 FL Primary

Addresses

Primary practice location

2145 Bob Phillips Rd
Bartow, FL 33830-6700

Mailing address

4200 Wackenhut Dr
West Palm Beach, FL 33410-4242
Phone (561) 691-6729

Other identifiers 1

IdentifierTypeStateIssuer
070754502MedicaidFL

Other names 1

  • Polk Halfway House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
G4S Youth Services LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284422400000",
    "number": "1356659288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 WACKENHUT DR",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334104242",
            "telephone_number": "561-691-6729",
            "fax_number": "561-691-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2145 BOB PHILLIPS RD",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338306700",
            "telephone_number": "863-519-5581",
            "fax_number": "863-519-6603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G4S YOUTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-14",
        "last_updated": "2010-09-14",
        "status": "A",
        "authorized_official_last_name": "KNOTT",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "561-691-6729",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "070754502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070754502",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polk Halfway House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bartow, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.