Healthcare Provider Details

I. General information

NPI: 1073710109
Provider Name (Legal Business Name): EASTER SEALS FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S CONGRESS AVE
WEST PALM BEACH FL
33409-3823
US

IV. Provider business mailing address

2010 CROSBY WAY
WINTER PARK FL
32792-4119
US

V. Phone/Fax

Practice location:
  • Phone: 561-881-2822
  • Fax: 561-881-0972
Mailing address:
  • Phone: 407-629-7881
  • Fax: 407-629-4754

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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. RIKESHA BLAKE
Title or Position: CFO
Credential:
Phone: 407-629-7881