Provider Demographics
NPI:1831279280
Name:EPIC COMMUNITY SERVICES, INC
Entity Type:Organization
Organization Name:EPIC COMMUNITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULSFUS
Authorized Official - Suffix:
Authorized Official - Credentials:MHL,BSN,RN-C
Authorized Official - Phone:904-829-2273
Mailing Address - Street 1:3910 LEWIS SPEEDWAY STE 1106
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-8649
Mailing Address - Country:US
Mailing Address - Phone:904-829-2273
Mailing Address - Fax:904-824-0724
Practice Address - Street 1:1400 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4190
Practice Address - Country:US
Practice Address - Phone:904-829-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0455AD258200251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070827500Medicaid