MEDICARE: ECKERD YOUTH ALTERNATIVES , INC. DBA ECKERD CONNECTS

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1629696836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECKERD YOUTH ALTERNATIVES , INC. DBA ECKERD CONNECTS

Provider Business Mailing Address
First Line	:	100 N STARCREST DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3224
Country	:	US
Telephone Number	:	727-461-2990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2226 SARNO RD STE 107
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-3087
Country	:	US
Telephone Number	:	321-253-0032
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	NICOLE STROEBEL
Credential	:
Telephone Number	:	727-461-2990

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	07/14/2020

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