Provider Demographics
NPI:1073984258
Name:ECKERD YOUTH ALTERNATIVES, INC. DBA ECKERD CONNECTS
Entity Type:Organization
Organization Name:ECKERD YOUTH ALTERNATIVES, INC. DBA ECKERD CONNECTS
Other - Org Name:ECKERD
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-461-2990
Mailing Address - Street 1:100 STARCREST DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3224
Mailing Address - Country:US
Mailing Address - Phone:727-461-2990
Mailing Address - Fax:
Practice Address - Street 1:1999 N AMIDON AVE
Practice Address - Street 2:SUITE 232
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2121
Practice Address - Country:US
Practice Address - Phone:316-440-5536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0072480-005253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency