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General NPI Number Information
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NPI Number | 1134245889
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Entity Type | Organization
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Legal Business Name | EASTER SEALS FLORIDA, INC.
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 2100 SE HILLMOOR DR STE 104
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-8057
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Country | US
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Telephone | 772-380-9972
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Fax | 772-380-9976
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Provider Business Mailing Address
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Address Line | 2010 CROSBY WAY
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City | WINTER PARK
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State | FL
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Zip | 32792-4119
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Country | US
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Telephone | 407-629-7881
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Fax | 407-629-4754
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Authorized Official
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Title or Position | CFO
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Name | MS. RIKESHA BLAKE
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Credential |
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Telephone | 407-629-7881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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