Provider Demographics
NPI:1659497386
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:407-629-4754
Practice Address - Street 1:2401 E HENRY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4434
Practice Address - Country:US
Practice Address - Phone:813-988-7633
Practice Address - Fax:813-914-0403
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:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880035900Medicaid
FL880035901Medicaid