Healthcare Provider Details

I. General information

NPI: 1477937969
Provider Name (Legal Business Name): PERSPECTIVES III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 E SILVER SPRINGS BLVD
OCALA FL
34470-6710
US

IV. Provider business mailing address

818 E SILVER SPRINGS BLVD
OCALA FL
34470-6710
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-3725
  • Fax: 352-622-3721
Mailing address:
  • Phone: 352-622-3725
  • Fax: 352-622-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number0542AD045901
License Number StateFL

VIII. Authorized Official

Name: JACK DONNELLY
Title or Position: CEO
Credential:
Phone: 352-347-6272