Healthcare Provider Details

I. General information

NPI: 1891743423
Provider Name (Legal Business Name): AGENCY FOR COMMUNITY TREATMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 N 56TH ST
TAMPA FL
33610-7123
US

IV. Provider business mailing address

4612 N 56TH ST
TAMPA FL
33610-7123
US

V. Phone/Fax

Practice location:
  • Phone: 813-246-4899
  • Fax: 813-621-6899
Mailing address:
  • Phone: 813-246-4899
  • Fax: 813-621-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062602
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062601
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062603
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062606
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062609
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062604
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062608
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062610
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062611
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062612
License Number StateFL
# 11
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberSR29AD062613
License Number StateFL

VIII. Authorized Official

Name: ASHA PEREYRA
Title or Position: CEP
Credential:
Phone: 813-246-4899