Basic Information
| Provider Information | |||||||||
| NPI: | 1992473888 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTER SEALS FLORIDA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 CROSBY WAY | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327924119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076297881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11440 N KENDALL DR STE 402 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331761025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059298705 | ||||||||
| FaxNumber: | 3056003713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2021 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | BLAKE | ||||||||
| AuthorizedOfficialFirstName: | RIKESHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5618812822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 111873300 | 05 | FL | MEDICAID | 892255101 | 05 | FL | MEDICAID |