Healthcare Provider Details

I. General information

NPI: 1780221903
Provider Name (Legal Business Name): ECHO COMMUNITY OUTREACH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 PALM COAST PKWY SW STE 103
PALM COAST FL
32137-4743
US

IV. Provider business mailing address

520 PALM COAST PKWY SW STE 103
PALM COAST FL
32137-4743
US

V. Phone/Fax

Practice location:
  • Phone: 386-225-4940
  • Fax:
Mailing address:
  • Phone: 386-225-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERT RAMIREZ
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 386-225-4940