Healthcare Provider Details

I. General information

NPI: 1952839201
Provider Name (Legal Business Name): OGLETHORPE OF ORLANDO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 BEEHIVE CIR
SAINT CLOUD FL
34769-1432
US

IV. Provider business mailing address

7074 GROVE RD STE 129
BROOKSVILLE FL
34609-8658
US

V. Phone/Fax

Practice location:
  • Phone: 885-973-7333
  • Fax:
Mailing address:
  • Phone: 813-978-1933
  • Fax: 352-610-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: TRACY ROBERTS
Title or Position: DIRECTOR REVENUE CYCLE MANAGEMENT
Credential:
Phone: 423-895-0084