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General NPI Number Information
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NPI Number | 1023456597
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Entity Type | Organization
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Legal Business Name | LA AMISTAD RESIDENTIAL TREATMENT CENTER INC
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 6601 CENTRAL FLORIDA PKWY
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City | ORLANDO
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State | FL
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Zip | 32821-8064
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Country | US
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Telephone | 407-264-0111
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Fax | 407-264-7745
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Provider Business Mailing Address
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Address Line | 6601 CENTRAL FLORIDA PKWY
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City | ORLANDO
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State | FL
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Zip | 32821-8064
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Country | US
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Telephone | 407-264-0111
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Fax | 407-264-7745
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Authorized Official
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Title or Position | CEO
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Name | VICKIE LEWIS
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Credential |
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Telephone | 407-370-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 4498
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License Number State | FL
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