MARION YOUTH DEVELOPMENT CENTER (NPI# 1629099890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629099890 |
| Entity Type | Organization |
| Organization Name | MARION YOUTH DEVELOPMENT CENTER |
| Practice Address |
4055 Nw 105th St Ocala FL 34482-1434 |
| Practice Telephone | 3526712777 |
| Practice Fax Number | 3523685940 |
| Mailing Telephone | 3526712777 |
| Mailing Fax Number | 3523685940 |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. BRENDA LYNN CARLSON (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 352 671 2777 |
| Authorized Official Credential | L.M.H.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities | ||
| X | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
1342AD5690 | FL | Residential Treatment Facilities |
| Street Address |
4055 NW 105TH ST |
| City | OCALA |
| State | FL |
| Zip Code | 34482-1434 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962420133 | Tracy Renee Miller | Counselor | 4055 Nw 105th St, Ocala, FL 34482-1434 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699200717 | Daniel Jay Cohn | Dermatology | 8250 Nw 136th Ave Rd., Ocala, FL 34482 | 2017-04-26 |
| 1972928554 | Tina R. Albritton | Home Health | 7575 West Us Highway 326, Ocala, FL 34482 | 2014-02-19 |
| 1831450055 | Jennifer Marie Nealis | Speech-Language Pathologist | 4200 Nw 89th Place, Ocala, FL 34482 | 2012-06-05 |
| 1164731626 | Success With No Limits | Exclusive Provider Organization | 948 N W 58th Court, Ocala, FL 34482 | 2010-10-01 |
| 1912127374 | Sajana Allin | Dentist | 4949 N Us Hwy 27, Ocala, FL 34482 | 2007-04-26 |
| 1053497784 | Pedro Alberto Orta | Chiropractor | 6998 N Us Highway 27, Suite 110, Ocala, FL 34482 | 2006-10-27 |
| 1942641220 | James Edward Gamble | Otolaryngology | 9860 W Highway 326, Ocala, FL 34482-1142 | 2013-07-15 |
| 1336478304 | Sequel Tsi of Florida, LLC Marion Program | Substance Abuse Rehabilitation Facility | 10420 Nw Gainesville Rd, Ocala, FL 34482-1446 | 2009-12-21 |
| 1609034339 | Jennifer Yarnell | Counselor | 11120 Nw Gainesville Rd, Ocala, FL 34482-1479 | 2008-05-29 |
| 1427692599 | Amber Lynn Werner | Family Medicine | 3700 Nw 111th Pl, Ocala, FL 34482-1480 | 2019-11-01 |
| Find all providers in zip 34482 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831748706 | The National Center for Life and Liberty | Residential Treatment Facility, Emotionally Disturbed Children | 13702 Green Isle Ter, Clermont, FL 34711-8426 | 2019-09-04 |
| 1881177509 | Sailfuture | Residential Treatment Facility, Emotionally Disturbed Children | 2900 68th Ave S, St Petersburg, FL 33712-5525 | 2018-09-09 |
| 1760892111 | Loving Arms Outreach, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 608 Nw 15th Ave, Pompano Beach, FL 33069-2829 | 2014-05-06 |
| 1689016560 | Alternate Group Care, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 20250 Sw 50th Pl, Southwest Ranches, FL 33332-1021 | 2013-07-22 |
| 1528304714 | Linda Newsome | Residential Treatment Facility, Emotionally Disturbed Children | 1454 Bent Oaks Blvd, Deland, FL 32724-8062 | 2012-12-17 |
| 1528327335 | G4s Youth Services LLC | Residential Treatment Facility, Emotionally Disturbed Children | 6302 Benjamin Rd Ste 400, Tampa, FL 33634-5116 | 2012-05-14 |
| 1003172073 | Esther's Group Home Corp. | Residential Treatment Facility, Emotionally Disturbed Children | 20115 Highland Lakes Blvd, N Miami Beach, FL 33179-2813 | 2012-04-04 |
| 1841584265 | D & R Rahabilitation Service Corp | Residential Treatment Facility, Emotionally Disturbed Children | 8567 Coral Way # 156, Miami, FL 33155-2335 | 2011-06-02 |
| 1003146887 | Sequel Tsi of Florida, LLC Daytona Transitional | Residential Treatment Facility, Emotionally Disturbed Children | 1386 Indian Lake Rd, Daytona Beach, FL 32124-1001 | 2009-12-30 |
| 1568795615 | Elite Behavioral Health Center | Residential Treatment Facility, Emotionally Disturbed Children | 611 Ne 13th St, Ft Lauderdale, FL 33304-1109 | 2009-09-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.