Provider Demographics
NPI:1760515977
Name:PRESCRIBED PEDIATRIC EXTENDED CARE, INC
Entity Type:Organization
Organization Name:PRESCRIBED PEDIATRIC EXTENDED CARE, INC
Other - Org Name:PEDIATRIC HEALTH CHOICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TOSTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-880-0320
Mailing Address - Street 1:8509 BENJAMIN ROAD
Mailing Address - Street 2:SUITE A D
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1224
Mailing Address - Country:US
Mailing Address - Phone:813-880-0220
Mailing Address - Fax:813-880-0221
Practice Address - Street 1:2355 DRUSILLA LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1443
Practice Address - Country:US
Practice Address - Phone:225-231-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6009096261QM3000X
FL60080968261QM3000X
FL60080972261QM3000X
FL60080962261QM3000X
FL60080977261QM3000X
FL6006096261QM3000X
FL60080966261QM3000X
FL6003096261QM3000X
FL60080982261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300003600Medicaid
FL300003605Medicaid
FL300003603Medicaid
FL650311001Medicaid
FL880567906Medicaid
FL880567901Medicaid
FL300003606Medicaid
FL880567903Medicaid
FL880567907Medicaid
FL882377400Medicaid
FL240005700Medicaid
FL300003604Medicaid
FL880567900Medicaid
FL880567905Medicaid
FL240012000Medicaid
FL300047800Medicaid
FL300256000Medicaid
FL300256001Medicaid
FL880567902Medicaid
FL880567904Medicaid