Healthcare Provider Details

I. General information

NPI: 1598447138
Provider Name (Legal Business Name): ECCI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 GARDEN STREET
NORTH FORT MYERS FL
33917-1883
US

IV. Provider business mailing address

1890 STATE ROAD 436 SUITE 300
WINTER PARK FL
32792-2285
US

V. Phone/Fax

Practice location:
  • Phone: 239-652-5604
  • Fax: 239-652-5606
Mailing address:
  • Phone: 407-645-3211
  • Fax: 407-645-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH SCHULTZ
Title or Position: PRESIDENT
Credential:
Phone: 407-645-3211