Provider Demographics
NPI:1235252602
Name:LA AMISTAD RESIDENTIAL TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:LA AMISTAD RESIDENTIAL TREATMENT CENTER LLC
Other - Org Name:CENTRAL FLORIDA BEHAVIORAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO SR VP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:1650 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6570
Mailing Address - Country:US
Mailing Address - Phone:407-370-0111
Mailing Address - Fax:
Practice Address - Street 1:6601 CENTRAL FLORIDA PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-8064
Practice Address - Country:US
Practice Address - Phone:407-370-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104072Medicare PIN