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2776 Cleveland Ave Fort Myers FL 33901-5864 | |
| (239) 242-6012 | |
| (239) 242-6088 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 2776 Cleveland Ave, Fort Myers, Florida |
| Authorized Official Name and Position | Mike German (CHEIF FINANCIAL OFFICER) |
| Authorized Official Contact | 2392426202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 150107 Cape Coral FL 33915-0107 Ph: (239) 242-6012 | 2776 Cleveland Ave Fort Myers FL 33901-5864 Ph: (239) 242-6012 |
| NPI Number | 1336475789 |
|---|---|
| Provider Enumeration Date | 10/20/2009 |
| Last Update Date | 01/25/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336475789 | NPI | - | NPPES |
| 010110900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 10-S012 (Florida) | Primary |
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