NPI Code Details Logo

NPI 1831047166

NPI 1831047166 : EASTERSEALS FLORIDA, INC. : PALM COAST, FL

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1831047166
-----------------------------------------------------
    Entity Type          |    Organization 
-----------------------------------------------------
    Legal Business Name  |    EASTERSEALS FLORIDA, INC. 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    03/20/2026
-----------------------------------------------------
    Last Update Date     |    03/20/2026
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    160 CYPRESS POINT PKWY STE A113 
-----------------------------------------------------
    City                 |    PALM COAST
-----------------------------------------------------
    State                |    FL
-----------------------------------------------------
    Zip                  |    32164-8450
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    386-873-0365
-----------------------------------------------------
    Fax                  |    386-868-1929
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    125 N RIDGEWOOD AVE STE 300 
-----------------------------------------------------
    City                 |    DAYTONA BEACH
-----------------------------------------------------
    State                |    FL
-----------------------------------------------------
    Zip                  |    32114-3284
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    386-944-7802
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    CFO
-----------------------------------------------------
    Name                 |    MS. RIKESHA  BLAKE 
-----------------------------------------------------
    Credential           |    
-----------------------------------------------------
    Telephone            |    407-287-5185
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    261Q00000X
-----------------------------------------------------
    Taxonomy Name        |    Clinic/Center
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
    Taxonomy Code        |    252Y00000X
-----------------------------------------------------
    Taxonomy Name        |    Early Intervention Provider Agency
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
    Taxonomy Code        |    251B00000X
-----------------------------------------------------
    Taxonomy Name        |    Case Management Agency
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------



                        

Copyright © 2007-2026 Data Labs Health. All rights reserved.