Provider Demographics
NPI:1063829539
Name:FAMILY ADVOCATES
Entity type:Organization
Organization Name:FAMILY ADVOCATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TARGETED CASE MANAGER POSITION
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:TARIQ
Authorized Official - Last Name:COLLINS EL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:407-319-4498
Mailing Address - Street 1:767 W GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9441
Mailing Address - Country:US
Mailing Address - Phone:407-319-4498
Mailing Address - Fax:
Practice Address - Street 1:767 W GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9441
Practice Address - Country:US
Practice Address - Phone:407-319-4498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010459700Medicaid