MEDICARE: LITTLE SAILORS HEALTHCARE CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1073493805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE SAILORS HEALTHCARE CORP

Provider Business Mailing Address
First Line	:	506 NE 24TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-4335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 NE 24TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-4335
Country	:	US
Telephone Number	:	239-446-7227
Fax Number	:

Authorized Official
Title or Position	:	VP/CEO
Name	:	EDIEL TIEL
Credential	:
Telephone Number	:	239-413-6059

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	02/11/2026

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Directions to “LITTLE SAILORS HEALTHCARE CORP ” Practice Location

Language	Start Address	Practice Location

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