Provider Demographics
NPI:1932674538
Name:FLORIDA TREATMENT FOR CHANGE INC
Entity Type:Organization
Organization Name:FLORIDA TREATMENT FOR CHANGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARI-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-333-8079
Mailing Address - Street 1:2917 NE 4TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-6804
Mailing Address - Country:US
Mailing Address - Phone:239-333-8079
Mailing Address - Fax:
Practice Address - Street 1:2180 MARAVILLA LN STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7221
Practice Address - Country:US
Practice Address - Phone:239-202-8993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty