Provider Demographics
NPI:1891743423
Name:AGENCY FOR COMMUNITY TREATMENT SERVICES INC
Entity Type:Organization
Organization Name:AGENCY FOR COMMUNITY TREATMENT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEP
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREYRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-246-4899
Mailing Address - Street 1:4612 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-7123
Mailing Address - Country:US
Mailing Address - Phone:813-246-4899
Mailing Address - Fax:813-621-6899
Practice Address - Street 1:4612 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-7123
Practice Address - Country:US
Practice Address - Phone:813-246-4899
Practice Address - Fax:813-621-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSR29AD062602251V00000X
FLSR29AD062601251V00000X
FLSR29AD062603251V00000X
FLSR29AD062606251V00000X
FLSR29AD062609251V00000X
FLSR29AD062604251V00000X
FLSR29AD062608251V00000X
FLSR29AD062610251V00000X
FLSR29AD062611251V00000X
FLSR29AD062612251V00000X
FLSR29AD062613251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060556510Medicaid
FL060556505Medicaid
FL060556511Medicaid
FL060556503Medicaid
FL060556509Medicaid
FL060556500Medicaid
FL060556508Medicaid