MEDICARE: ECCI, 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
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1598447138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECCI, LLC

Provider Business Mailing Address
First Line	:	1890 STATE ROAD 436
Second Line	:	SUITE 300
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2285
Country	:	US
Telephone Number	:	407-645-3211
Fax Number	:	407-645-3011

Provider Business Practice Location Address
First Line	:	2951 GARDEN STREET
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-1883
Country	:	US
Telephone Number	:	239-652-5604
Fax Number	:	239-652-5606

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KENNETH SCHULTZ
Credential	:
Telephone Number	:	407-645-3211

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	08/03/2023

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