Provider Demographics
NPI:1497324495
Name:CENTERSTONE OF FLORIDA, INC.
Entity Type:Organization
Organization Name:CENTERSTONE OF FLORIDA, INC.
Other - Org Name:CENTERSTONE FACT LEE NORTH & SOUTH AND CAT LEE
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-782-4299
Mailing Address - Street 1:PO BOX 9478
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-9478
Mailing Address - Country:US
Mailing Address - Phone:941-782-4150
Mailing Address - Fax:941-782-4301
Practice Address - Street 1:4350 FOWLER ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-2699
Practice Address - Country:US
Practice Address - Phone:941-782-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health