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General NPI Number Information
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NPI Number | 1952847345
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Entity Type | Organization
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Legal Business Name | AMERICAN HEALTH CARE COMMUNITY BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 3326 ROBERT TRENT JONES DR APT. 408
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City | ORLANDO
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State | FL
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Zip | 32835-2370
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Country | US
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Telephone | 407-963-4335
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Fax |
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Provider Business Mailing Address
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Address Line | 3326 ROBERT TRENT JONES DR APT. 408
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City | ORLANDO
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State | FL
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Zip | 32835-2370
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Country | US
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Telephone | 407-963-4335
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ROBERTA V OLIVEIRA MATOS
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Credential | MS
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Telephone | 407-963-4335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | IMH 12426
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License Number State | FL
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