Provider Demographics
NPI:1295756385
Name:GAINESVILLE PSYCHIATRY AND FORENSIC SERVICES L.L.C.
Entity type:Organization
Organization Name:GAINESVILLE PSYCHIATRY AND FORENSIC SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:OZOEMEZINEM
Authorized Official - Last Name:ADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-378-9116
Mailing Address - Street 1:1103 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6116
Mailing Address - Country:US
Mailing Address - Phone:352-378-9116
Mailing Address - Fax:352-378-9779
Practice Address - Street 1:1103 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-378-9116
Practice Address - Fax:352-378-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84024261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024658500Medicaid