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NPI Code Detail

MEDICARE: PRESCRIBED PEDIATRIC EXTENDED CARE INC.

MEDICARE: PRESCRIBED PEDIATRIC EXTENDED CARE INC.
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 : 1790033256
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRESCRIBED PEDIATRIC EXTENDED CARE INC.
Provider Business Mailing Address
First Line : 4144 N ARMENIA AVE STE 350
Second Line :
City : TAMPA
State : FL
Zip : 33607-6434
Country : US
Telephone Number : 813-872-8521
Fax Number : 813-200-3707
Provider Business Practice Location Address
First Line : 4144 N ARMENIA AVE STE 350
Second Line :
City : TAMPA
State : FL
Zip : 33607-6434
Country : US
Telephone Number : 813-872-8521
Fax Number : 813-200-3707
Authorized Official
Title or Position : BEHAVIOR SPECIALIST
Name : MS. STEPHANIE RHIANNON WACK
Credential :
Telephone Number : 727-804-4748
Provider Enumeration Date : 08/15/2012
Last Update Date : 08/15/2012

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Directions to “PRESCRIBED PEDIATRIC EXTENDED CARE INC. ” Practice Location

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