1902939820 NPI number — CENTRAL FLORIDA MENTAL HEALTH

Table of content: (NPI 1902939820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902939820 NPI number — CENTRAL FLORIDA MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL FLORIDA MENTAL HEALTH
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:
1902939820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 N HIGHWAY 27
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CLERMONT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34711-2431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-536-2364
Provider Business Mailing Address Fax Number:
352-536-2370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 N HIGHWAY 27
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711-2431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-536-2364
Provider Business Practice Location Address Fax Number:
352-536-2370
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KELLEY
Authorized Official First Name:
TORI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER COUNSELOR
Authorized Official Telephone Number:
352-536-2364

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH7472 , 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: 72149600 . This is a "MAGELLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HARMONY . This is a "276309" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 535703 . This is a "VALUE OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0007392583 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1197964 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Z080U . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3290746 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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