Provider Demographics
NPI:1306974696
Name:ACT CORPORATION
Entity type:Organization
Organization Name:ACT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SPECIALIST V
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:PATTERSON
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:386-236-1812
Mailing Address - Street 1:1350 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-3802
Mailing Address - Country:US
Mailing Address - Phone:386-774-2807
Mailing Address - Fax:386-236-3137
Practice Address - Street 1:1350 ALMOND ST
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-3802
Practice Address - Country:US
Practice Address - Phone:386-774-2807
Practice Address - Fax:386-236-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid