Provider Demographics
NPI:1750349742
Name:CFSATC INC
Entity type:Organization
Organization Name:CFSATC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:407-872-3000
Mailing Address - Street 1:1800 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7012
Mailing Address - Country:US
Mailing Address - Phone:407-843-0041
Mailing Address - Fax:407-841-7078
Practice Address - Street 1:1800 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7012
Practice Address - Country:US
Practice Address - Phone:407-843-0041
Practice Address - Fax:407-841-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH11072101YA0400X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075363703Medicaid