Provider Demographics
NPI:1972080299
Name:EASTER SEALS SOUTH FLORIDA, INC.
Entity Type:Organization
Organization Name:EASTER SEALS SOUTH FLORIDA, INC.
Other - Org Name:EASTER SEALS THERAPEUTIC DAY CARE - KENDALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF ADULT DAY CARE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARACENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-325-0470
Mailing Address - Street 1:1475 NW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1692
Mailing Address - Country:US
Mailing Address - Phone:305-325-0470
Mailing Address - Fax:
Practice Address - Street 1:11025 SW 84TH ST STE 12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3856
Practice Address - Country:US
Practice Address - Phone:305-325-0470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTER SEALS SOUTH FLORIDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-20
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9423261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100298100Medicaid