Provider Demographics
NPI:1740884741
Name:FLORIDA TREATMENT SERVICES LLC
Entity type:Organization
Organization Name:FLORIDA TREATMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WENDELL
Authorized Official - Last Name:COPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-220-7288
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:12191 WEST LINEBAUGH AVENUE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-0745
Mailing Address - Country:US
Mailing Address - Phone:803-220-7288
Mailing Address - Fax:
Practice Address - Street 1:733 S GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8100
Practice Address - Country:US
Practice Address - Phone:803-220-7288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone