Provider Demographics
NPI:1598798506
Name:FLORIDA BEHAVIORAL HEALTHCARE, INC
Entity Type:Organization
Organization Name:FLORIDA BEHAVIORAL HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-376-6200
Mailing Address - Street 1:3135 STATE ROAD 580
Mailing Address - Street 2:STE 7
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4976
Mailing Address - Country:US
Mailing Address - Phone:727-530-1340
Mailing Address - Fax:727-535-7869
Practice Address - Street 1:3135 STATE ROAD 580
Practice Address - Street 2:STE 7
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4976
Practice Address - Country:US
Practice Address - Phone:727-530-1340
Practice Address - Fax:727-535-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4561261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101498Medicare Oscar/Certification