Healthcare Provider Details

I. General information

NPI: 1124976451
Provider Name (Legal Business Name): EASTERSEALS FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N RIDGEWOOD AVE STE 200
DAYTONA BEACH FL
32114-3283
US

IV. Provider business mailing address

125 N RIDGEWOOD AVE STE 300
DAYTONA BEACH FL
32114-3284
US

V. Phone/Fax

Practice location:
  • Phone: 877-255-4568
  • Fax: 386-873-0366
Mailing address:
  • Phone: 386-944-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. RIKESHA BLAKE
Title or Position: CFO
Credential:
Phone: 407-287-5185