Provider Demographics
NPI:1508129446
Name:ABOVE AND BEYOND: CHILDREN & COMMUNITY SERVICES
Entity Type:Organization
Organization Name:ABOVE AND BEYOND: CHILDREN & COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-492-8770
Mailing Address - Street 1:2575 WESTMINSTER TER
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7568
Mailing Address - Country:US
Mailing Address - Phone:407-492-8770
Mailing Address - Fax:
Practice Address - Street 1:705 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1121
Practice Address - Country:US
Practice Address - Phone:407-492-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017116000Medicaid