Healthcare Provider Details

I. General information

NPI: 1245370626
Provider Name (Legal Business Name): ECCI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S LAKE DESTINY RD
ORLANDO FL
32810-6238
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 407-660-8330
  • Fax: 407-660-1614
Mailing address:
  • Phone: 407-645-3211
  • Fax: 407-628-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberF593197713001
License Number StateFL

VIII. Authorized Official

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