1932674538 NPI number — FLORIDA TREATMENT FOR CHANGE INC

Table of content: (NPI 1932674538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932674538 NPI number — FLORIDA TREATMENT FOR CHANGE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA TREATMENT FOR CHANGE 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:
1932674538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2917 NE 4TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33909-6804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-333-8079
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2180 MARAVILLA LN STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901-7221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-202-8993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SPILLER
Authorized Official First Name:
KARI-ANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
239-333-8079

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com