Healthcare Provider Details

I. General information

NPI: 1437536224
Provider Name (Legal Business Name): CHARLOTTE BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 EDUCATION AVE
PUNTA GORDA FL
33950-6222
US

IV. Provider business mailing address

1700 EDUCATION AVE
PUNTA GORDA FL
33950-6222
US

V. Phone/Fax

Practice location:
  • Phone: 941-639-8300
  • Fax:
Mailing address:
  • Phone: 941-639-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH12907
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA SCANLON
Title or Position: CEO
Credential: LMHC
Phone: 941-639-8300