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NPI Code Detail

MEDICARE: HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS, LLC

MEDICARE: HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1073871208
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS, LLC
Provider Business Mailing Address
First Line : 1001 E BAKER ST STE 100
Second Line :
City : PLANT CITY
State : FL
Zip : 33563-3700
Country : US
Telephone Number : 813-754-5555
Fax Number : 813-754-5552
Provider Business Practice Location Address
First Line : 3049 CLEVELAND AVE STE 290
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-7054
Country : US
Telephone Number : 813-754-5555
Fax Number : 813-754-5552
Authorized Official
Title or Position : CEO
Name : EDWARD A. WALLER JR.
Credential : M.ED.
Telephone Number : 813-754-5555
Provider Enumeration Date : 04/25/2012
Last Update Date : 07/27/2018

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