Provider Demographics
NPI:1427194430
Name:THE CENTER FOR DRUG FREE LIVING
Entity Type:Organization
Organization Name:THE CENTER FOR DRUG FREE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-245-0045
Mailing Address - Street 1:5151 ADANSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1330
Mailing Address - Country:US
Mailing Address - Phone:407-245-0045
Mailing Address - Fax:407-245-0049
Practice Address - Street 1:5151 ADANSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1330
Practice Address - Country:US
Practice Address - Phone:407-245-0045
Practice Address - Fax:407-245-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060420800Medicaid