Organization
ACTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIA D LEWIS (UTILIZATION REVIEW MANAGER)
(813) 626-7250
Entity
Organization
Contact information
Practice address
3575 OLD KEYSTONE RD, TARPON SPRINGS, FL 34688-7807
(727) 942-4181
Mailing address
4612 N 56TH ST, TAMPA, FL 33610-7123
(813) 626-7250
(813) 367-2579
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/12/2012
Last updated
12/12/2012
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