Provider Demographics
NPI:1508050147
Name:CFSATC INC
Entity Type:Organization
Organization Name:CFSATC INC
Other - Org Name:CENTRAL FLORIDA TREATMENT CENTER LAKE WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEESSY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MCAP, MAC, LMHC
Authorized Official - Phone:321-951-9750
Mailing Address - Street 1:3155 LAKE WORTH ROAD SUITE #2
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:561-439-8440
Mailing Address - Fax:
Practice Address - Street 1:3155 LAKE WORTH ROAD SUITE #2
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-439-8440
Practice Address - Fax:561-439-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0950AD125701251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075363700Medicaid