Provider Demographics
NPI:1316199029
Name:FLORIDA COMMUNITY BEHAVIORAL CARE INC
Entity Type:Organization
Organization Name:FLORIDA COMMUNITY BEHAVIORAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GENER
Authorized Official - Middle Name:
Authorized Official - Last Name:BROJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-642-7803
Mailing Address - Street 1:6610 EMBASSY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4897
Mailing Address - Country:US
Mailing Address - Phone:727-849-2255
Mailing Address - Fax:727-849-2202
Practice Address - Street 1:6610 EMBASSY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4897
Practice Address - Country:US
Practice Address - Phone:727-849-2255
Practice Address - Fax:727-849-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7933261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)