Healthcare Provider Details

I. General information

NPI: 1265844013
Provider Name (Legal Business Name): PRESCRIBED PEDIATRIC EXTENDED CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 JACKSON ST
ALEXANDRIA LA
71303-2324
US

IV. Provider business mailing address

8509 BENJAMIN RD SUITE D
TAMPA FL
33634-1224
US

V. Phone/Fax

Practice location:
  • Phone: 318-625-0410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: HEIDI TOSTI
Title or Position: VP FINANCE
Credential:
Phone: 813-769-5358