=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447343009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST STEP ADOLESCENT SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 459 LAKE OPAL CT
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-6968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-880-3894
-----------------------------------------------------
Fax | 407-880-8304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 EXCELSIOR PKWY SUITE 205
-----------------------------------------------------
City | WINTER SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32708-2569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-327-2901
-----------------------------------------------------
Fax | 407-327-2780
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MRS. CHERYL ANITA SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-327-2901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3245S0500X
-----------------------------------------------------
Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 0748AD120901
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------