1861689135 NPI number — CFSATC INC

Table of content: (NPI 1861689135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861689135 NPI number — CFSATC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CFSATC 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:
CENTRAL FLORIDA TREATMENT CENTERS FORT PIERCE
Provider Other Organization Name Type Code:
3
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:
1861689135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1302 N LAWNWOOD CIR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT PIERCE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34950-4884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-468-6800
Provider Business Mailing Address Fax Number:
772-464-3800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1302 N LAWNWOOD CIR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT PIERCE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34950-4884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-468-6800
Provider Business Practice Location Address Fax Number:
772-464-3800
Provider Enumeration Date:
10/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KNEESSY
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL DIRECTOR
Authorized Official Telephone Number:
321-951-9750

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1956AD125700 , 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)