Provider Demographics
NPI:1922369792
Name:UNITED CEREBRAL PALSY OF EAST CENTRAL FLORIDA, INC.
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF EAST CENTRAL FLORIDA, INC.
Other - Org Name:UCP/WORC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-274-6474
Mailing Address - Street 1:1100 JIMMY ANN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3920
Mailing Address - Country:US
Mailing Address - Phone:386-274-6474
Mailing Address - Fax:386-274-6532
Practice Address - Street 1:1100 JIMMY ANN DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-3920
Practice Address - Country:US
Practice Address - Phone:386-274-6474
Practice Address - Fax:386-274-6532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023962396Medicaid