Healthcare Provider Details

I. General information

NPI: 1366816118
Provider Name (Legal Business Name): OCALA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 SW 27TH AVE
OCALA FL
34471-4306
US

IV. Provider business mailing address

3130 SW 27TH AVE
OCALA FL
34471-4306
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-3130
  • Fax: 352-387-0767
Mailing address:
  • Phone: 352-671-3130
  • Fax: 352-387-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN QUINTYNE
Title or Position: CEO
Credential:
Phone: 352-671-3130