1427194430 NPI number — THE CENTER FOR DRUG FREE LIVING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427194430 NPI number — THE CENTER FOR DRUG FREE LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CENTER FOR DRUG FREE LIVING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427194430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5151 ADANSON ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32804-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-245-0045
Provider Business Mailing Address Fax Number:
407-245-0049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 ADANSON ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32804-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-245-0045
Provider Business Practice Location Address Fax Number:
407-245-0049
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HORST
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
407-245-0045

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 060420800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005388700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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