Healthcare Provider Details

I. General information

NPI: 1528351335
Provider Name (Legal Business Name): EASTER SEALS SOUTHWEST FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BRADEN AVE
SARASOTA FL
34243-2001
US

IV. Provider business mailing address

350 BRADEN AVE
SARASOTA FL
34243-2001
US

V. Phone/Fax

Practice location:
  • Phone: 941-355-7637
  • Fax: 941-359-1555
Mailing address:
  • Phone: 941-355-7637
  • Fax: 941-359-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. WILLIAM LADDISON WALDO
Title or Position: PRESIDENT & CEO
Credential: CPA
Phone: 941-355-7637