Provider Demographics
NPI:1629696836
Name:ECKERD YOUTH ALTERNATIVES , INC. DBA ECKERD CONNECTS
Entity Type:Organization
Organization Name:ECKERD YOUTH ALTERNATIVES , INC. DBA ECKERD CONNECTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STROEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-461-2990
Mailing Address - Street 1:100 N 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 1:2226 SARNO RD STE 107
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3087
Practice Address - Country:US
Practice Address - Phone:321-253-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management