=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780329359
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CFSATC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2022
-----------------------------------------------------
Last Update Date | 04/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1825 JESS PARRISH CT
-----------------------------------------------------
City | TITUSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32796-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-567-4460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1810 W COLONIAL DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-7012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-760-1173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES/EXEC DIR/CEO
-----------------------------------------------------
Name | CAROL S BALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-872-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------