Provider Demographics
NPI:1861814022
Name:OGLETHORPE OF ST CLOUD LLC
Entity Type:Organization
Organization Name:OGLETHORPE OF ST CLOUD LLC
Other - Org Name:HEROES MILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANNINE
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-978-1933
Mailing Address - Street 1:7074 GROVE RD STE 129
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8658
Mailing Address - Country:US
Mailing Address - Phone:352-597-5075
Mailing Address - Fax:
Practice Address - Street 1:2775 BIG JOHN DR
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4000
Practice Address - Country:US
Practice Address - Phone:386-337-7957
Practice Address - Fax:386-337-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
323P00000X
FL0949AD581501324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility