Provider Demographics
NPI:1710332671
Name:AMERICAN HEALTHCARE COMMUNITY BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTHCARE COMMUNITY BEHAVIORAL SERVICES LLC
Other - Org Name:AMERICAN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZIGLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:321-228-4134
Mailing Address - Street 1:1203 FLORIDA AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769
Mailing Address - Country:US
Mailing Address - Phone:407-593-1062
Mailing Address - Fax:407-277-7622
Practice Address - Street 1:1203 FLORIDA AVE.
Practice Address - Street 2:
Practice Address - City:ST. CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769
Practice Address - Country:US
Practice Address - Phone:407-593-1062
Practice Address - Fax:407-277-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2452101YM0800X
1041C0700X, 261QM0801X
FLCCMS100378-AC106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015614700Medicaid