MEDICARE: EURIKA EXILE

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
1	251C00000X	Developmentally Disabled Services Day Training Agency	07489634Z	FL

General Provider Information

NPI Number	:	1215874235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EURIKA EXILE

Provider Business Mailing Address
First Line	:	4559 W GORE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-4536
Country	:	US
Telephone Number	:	407-252-4274
Fax Number	:

Provider Business Practice Location Address
First Line	:	4559 W GORE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-4536
Country	:	US
Telephone Number	:	407-252-4274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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Directions to “ EURIKA EXILE ” Practice Location

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