Organization
SOUTHWEST FLORIDA ADDICTION SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY J. PARHAM (IT DIRECTOR)
(239) 332-6937
Entity
Organization
Contact information
Practice address
3763 EVANS AVENUE, FT MYERS, FL 33901
(239) 332-6937
(239) 332-0287
Mailing address
3763 EVANS AVENUE, FT. MYERS, FL 33901
(239) 332-6937
(239) 332-0287
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
CH1152
FL
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0115162
AETNA MANAGEMENT
TX
05
—
060613800
—
FL
01
—
189858
COMPSYCH CORPORATION
IL
Enumeration date
04/17/2006
Last updated
11/10/2011
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