Provider Demographics
NPI:1265510523
Name:CHILDREN'S CARE CAMPUS, INC.
Entity Type:Organization
Organization Name:CHILDREN'S CARE CAMPUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SERVICES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OHLMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-513-3000
Mailing Address - Street 1:4448 EDGE WATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1216
Mailing Address - Country:US
Mailing Address - Phone:407-513-3000
Mailing Address - Fax:407-515-6537
Practice Address - Street 1:196 SOUTH SEMORAN BLVD.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3293
Practice Address - Country:US
Practice Address - Phone:407-513-3000
Practice Address - Fax:407-515-6537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60080980225100000X, 2251P0200X, 225X00000X, 225XP0200X, 227800000X, 2278P3900X, 235Z00000X, 261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
No2278P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedNeonatal/PediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL240014601Medicaid