Provider Demographics
NPI:1881136505
Name:AMERICAN CENTER FOR INTELLECTUAL AND DIVERSE DISORDERS FLORIDA, INC
Entity type:Organization
Organization Name:AMERICAN CENTER FOR INTELLECTUAL AND DIVERSE DISORDERS FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABY
Authorized Official - Middle Name:
Authorized Official - Last Name:OOMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-221-8282
Mailing Address - Street 1:20617 WHITEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3216
Mailing Address - Country:US
Mailing Address - Phone:862-221-8282
Mailing Address - Fax:
Practice Address - Street 1:20617 WHITEWOOD WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3216
Practice Address - Country:US
Practice Address - Phone:862-221-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities