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General NPI Number Information
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NPI Number | 1518921337
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Entity Type | Organization
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Legal Business Name | SOUTHWEST FLORIDA ADDICTION SERVICE
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 3763 EVANS AVENUE
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City | FT MYERS
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State | FL
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Zip | 33901
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Country | US
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Telephone | 239-332-6937
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Fax | 239-332-0287
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Provider Business Mailing Address
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Address Line | 3763 EVANS AVENUE
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City | FT. MYERS
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State | FL
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Zip | 33901
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Country | US
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Telephone | 239-332-6937
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Fax | 239-332-0287
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Authorized Official
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Title or Position | IT DIRECTOR
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Name | TIMOTHY J. PARHAM
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Credential |
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Telephone | 239-332-6937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | CH1152
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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