Provider Demographics
NPI:1598881153
Name:EASTER SEALS FLORIDA, INC.
Entity Type:Organization
Organization Name:EASTER SEALS FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:RIKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-629-7881
Mailing Address - Street 1:2010 CROSBY WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4119
Mailing Address - Country:US
Mailing Address - Phone:407-629-7881
Mailing Address - Fax:407-294-7546
Practice Address - Street 1:2010 CROSBY WAY
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4119
Practice Address - Country:US
Practice Address - Phone:407-629-7881
Practice Address - Fax:407-629-4754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTER SEALS FLORIDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL677108400Medicaid
FL110726200Medicaid
FL683166400Medicaid