1053025908 NPI number — INSIGHT BEHAVIORAL HEALTH & ADDICTION SOLUTIONS INC

Table of content: CORINA DOCTRINE ND (NPI 1093346595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053025908 NPI number — INSIGHT BEHAVIORAL HEALTH & ADDICTION SOLUTIONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT BEHAVIORAL HEALTH & ADDICTION SOLUTIONS 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:
CLEAN RECOVERY CENTERS
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:
1053025908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 W FLETCHER AVE STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33612-3413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
883-302-5328
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 CLEARWATER LARGO RD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33770-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-330-2532
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
TZATZIMAKIS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
888-330-2532

Provider Taxonomy Codes

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

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





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