Healthcare Provider Details

I. General information

NPI: 1407292584
Provider Name (Legal Business Name): ECKERD YOUTH ALTERNATIVES, INC. DBA ECKERD CONNECTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 S WESTERN AVE SUITE 600
OKLAHOMA CITY OK
73109-4520
US

IV. Provider business mailing address

100 STARCREST DR
CLEARWATER FL
33765-3224
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-5956
  • Fax: 405-636-5962
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID DENNIS
Title or Position: CEO
Credential:
Phone: 727-461-2990