Healthcare Provider Details

I. General information

NPI: 1497324495
Provider Name (Legal Business Name): CENTERSTONE OF FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 FOWLER ST
FORT MYERS FL
33901-2699
US

IV. Provider business mailing address

PO BOX 9478
BRADENTON FL
34206-9478
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4150
  • Fax:
Mailing address:
  • Phone: 941-782-4150
  • Fax: 941-782-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SEAN GINGRAS
Title or Position: REGIONAL FINANCE OFFICER
Credential:
Phone: 941-782-4299