Provider Demographics
NPI:1336218486
Name:ECKERD YOUTH ALTERNATIVES
Entity Type:Organization
Organization Name:ECKERD YOUTH ALTERNATIVES
Other - Org Name:ECKERD CONNECTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STROEBEL
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:727-216-0055
Practice Address - Street 1:4654 HIGH ROCK RD
Practice Address - Street 2:
Practice Address - City:BOOMER
Practice Address - State:NC
Practice Address - Zip Code:28606-9109
Practice Address - Country:US
Practice Address - Phone:336-921-3300
Practice Address - Fax:336-921-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty