Provider Demographics
NPI:1952847345
Name:AMERICAN HEALTH CARE COMMUNITY BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTH CARE COMMUNITY BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:V
Authorized Official - Last Name:OLIVEIRA MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:407-963-4335
Mailing Address - Street 1:3326 ROBERT TRENT JONES DR
Mailing Address - Street 2:APT. 408
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2370
Mailing Address - Country:US
Mailing Address - Phone:407-963-4335
Mailing Address - Fax:
Practice Address - Street 1:3326 ROBERT TRENT JONES DR
Practice Address - Street 2:APT. 408
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2370
Practice Address - Country:US
Practice Address - Phone:407-963-4335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 12426251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health