Healthcare Provider Details

I. General information

NPI: 1992473888
Provider Name (Legal Business Name): EASTER SEALS FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7990 SW 117TH AVE STE 125
MIAMI FL
33183-3845
US

IV. Provider business mailing address

2010 CROSBY WAY
WINTER PARK FL
32792-4119
US

V. Phone/Fax

Practice location:
  • Phone: 305-929-8705
  • Fax: 305-600-3713
Mailing address:
  • Phone: 407-629-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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