Provider Demographics
NPI:1548860109
Name:ACT FLORIDA, LLC
Entity type:Organization
Organization Name:ACT FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YAIMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-306-0505
Mailing Address - Street 1:2413 MAIN ST # 326
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7809
Mailing Address - Country:US
Mailing Address - Phone:786-306-0505
Mailing Address - Fax:
Practice Address - Street 1:12505 ORANGE DR STE 908
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4300
Practice Address - Country:US
Practice Address - Phone:786-306-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023444500Medicaid