Provider Demographics
NPI:1235203035
Name:EASTER SEALS SOUTH FLORIDA
Entity Type:Organization
Organization Name:EASTER SEALS SOUTH FLORIDA
Other - Org Name:EASTER SEALS THERAPEUTIC DAY CARE-HIALEAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARACENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-325-0470
Mailing Address - Street 1:1475 NW 14TH AVE.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:305-325-0470
Mailing Address - Fax:305-325-0578
Practice Address - Street 1:1475 NW 14TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1616
Practice Address - Country:US
Practice Address - Phone:305-325-0470
Practice Address - Fax:786-422-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X, 252Y00000X
FL8960261QA0600X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880264500Medicaid
FL024987405Medicaid
FL880264500Medicaid