Organization
ACTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHA PEREYRA (CEO)
(813) 246-4899
Entity
Organization
Contact information
Practice address
4612 N 56TH ST, TAMPA, FL 33610-7123
(813) 246-4899
(813) 621-6899
Mailing address
4612 N 56TH ST, TAMPA, FL 33610-7123
(813) 246-4899
(813) 621-6899
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1329AD062601
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060556500
—
FL
Enumeration date
09/18/2012
Last updated
10/19/2022
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