Provider Demographics
NPI:1730961806
Name:ADVENTURE BEHAVIORAL SERVICES CORP
Entity type:Organization
Organization Name:ADVENTURE BEHAVIORAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER,CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENAS REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-306-2140
Mailing Address - Street 1:3705 FOUNTAINBLEU BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3223
Mailing Address - Country:US
Mailing Address - Phone:407-698-7969
Mailing Address - Fax:
Practice Address - Street 1:3705 FOUNTAINBLEU BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3223
Practice Address - Country:US
Practice Address - Phone:407-698-7969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty