MEDICARE: ECKERD YOUTH ALTERNATIVES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253J00000X	Foster Care Agency
2	323P00000X	Psychiatric Residential Treatment Facility
3	101YP2500X	Professional Counselor
4	103TC0700X	Clinical Psychologist
5	1041C0700X	Clinical Social Worker
6	2084P0804X	Child & Adolescent Psychiatry Physician
7	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275602302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECKERD YOUTH ALTERNATIVES, INC.

Provider Business Mailing Address
First Line	:	100 STARCREST DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3224
Country	:	US
Telephone Number	:	727-461-2990
Fax Number	:

Provider Business Practice Location Address
First Line	:	7027 E STAGE COACH TRAIL
Second Line	:
City	:	FLORAL CITY
State	:	FL
Zip	:	34436-3542
Country	:	US
Telephone Number	:	352-726-3883
Fax Number	:	352-726-3260

Authorized Official
Title or Position	:	CFO
Name	:	DAVID DENNIS
Credential	:
Telephone Number	:	727-461-2990

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/01/2021

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