Healthcare Provider Details
I. General information
NPI: 1043090384
Provider Name (Legal Business Name): METRO TREATMENT OF FLORIDA, LP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1497 FOREST HILL BLVD STE E
LAKE CLARKE SHORES FL
33406-6052
US
IV. Provider business mailing address
2500 MAITLAND CENTER PKWY
MAITLAND FL
32751-7224
US
V. Phone/Fax
- Phone: 561-433-5687
- Fax: 561-433-5705
- Phone: 407-351-7080
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251S00000X |
| Taxonomy | Community/Behavioral Health Agency |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QM2800X |
| Taxonomy | Methadone Clinic |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
SARAH
CHAPMAN
Title or Position: PAYOR RELATIONS
Credential:
Phone: 407-351-7080