Provider Demographics
NPI:1497875009
Name:COMMUNITY TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:COMMUNITY TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHCCAP
Authorized Official - Phone:321-632-5958
Mailing Address - Street 1:1215 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-6293
Mailing Address - Country:US
Mailing Address - Phone:321-632-5958
Mailing Address - Fax:321-632-2533
Practice Address - Street 1:1215 LAKE DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-6293
Practice Address - Country:US
Practice Address - Phone:321-632-5958
Practice Address - Fax:321-632-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0705AD196001324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility