1144251638 NPI number — CENTERSTONE OF FLORIDA, INC.

Table of content: (NPI 1144251638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144251638 NPI number — CENTERSTONE OF FLORIDA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERSTONE OF FLORIDA, INC.
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:
1144251638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 9478
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34206-9478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-782-4299
Provider Business Mailing Address Fax Number:
941-782-4301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 26TH AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34208-7753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-782-4600
Provider Business Practice Location Address Fax Number:
941-782-4601
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GINGRAS
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL FINANCE OFFICER
Authorized Official Telephone Number:
941-782-4299

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 12-41-AD-9537-01 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 12-41-AD-9537-03 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 12-41-AD-9537-05 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X , with the licence number: 12-41-AD-9537-06 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 12-41-AD-9537-07 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273R00000X , with the licence number: 1467 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X , with the licence number: 3977 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 260859600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004469304 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060280905 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060280900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060280901 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060280910 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004469301 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004469303 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004469305 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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