Healthcare Provider Details

I. General information

NPI: 1740884741
Provider Name (Legal Business Name): FLORIDA TREATMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 S GOLDENROD RD
ORLANDO FL
32822-8100
US

IV. Provider business mailing address

PO BOX 745 12191 WEST LINEBAUGH AVENUE
TAMPA FL
33626-0745
US

V. Phone/Fax

Practice location:
  • Phone: 803-220-7288
  • Fax:
Mailing address:
  • Phone: 803-220-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. LARRY WENDELL COPLIN
Title or Position: CHIEF EXECUTIVE DIRECTOR
Credential:
Phone: 803-220-7288