Healthcare Provider Details

I. General information

NPI: 1710332671
Provider Name (Legal Business Name): AMERICAN HEALTHCARE COMMUNITY BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 FLORIDA AVE.
ST. CLOUD FL
34769
US

IV. Provider business mailing address

1203 FLORIDA AVE.
ST. CLOUD FL
34769
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-1062
  • Fax: 407-277-7622
Mailing address:
  • Phone: 407-593-1062
  • Fax: 407-277-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCCMS100378-AC
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMT2452
License Number StateFL

VIII. Authorized Official

Name: MR. DALE A. ZIGLEAR
Title or Position: OWNER/CEO
Credential: MT
Phone: 321-228-4134