Provider Demographics
NPI:1659643153
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-461-2990
Mailing Address - Street 1:100 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:727-261-0055
Practice Address - Street 1:1307 PETERMAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3437
Practice Address - Country:US
Practice Address - Phone:318-443-7900
Practice Address - Fax:318-443-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health