Provider Demographics
NPI:1811450620
Name:CFSATC, INC.
Entity type:Organization
Organization Name:CFSATC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEESSY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MAC, MCAP, LMHC
Authorized Official - Phone:321-951-9750
Mailing Address - Street 1:3181 DAVIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2728
Mailing Address - Country:US
Mailing Address - Phone:954-533-1670
Mailing Address - Fax:954-368-4645
Practice Address - Street 1:3181 DAVIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2728
Practice Address - Country:US
Practice Address - Phone:954-533-1670
Practice Address - Fax:954-368-4645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CFSATC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-09
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075363709Medicaid