1952759268 NPI number — CARROUSEL THERAPY CENTER CORPORATION

Table of content: (NPI 1952759268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952759268 NPI number — CARROUSEL THERAPY CENTER CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARROUSEL THERAPY CENTER CORPORATION
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:
1952759268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14000 SANCTUARY CREEK WAY UNIT 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32832-6617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-223-8185
Provider Business Mailing Address Fax Number:
321-966-4447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 N JOHN YOUNG PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-223-8185
Provider Business Practice Location Address Fax Number:
321-966-4447
Provider Enumeration Date:
05/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
407-319-6199

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008033500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117575100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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