Provider Demographics
NPI:1912676792
Name:EASTER SEALS FLORIDA, INC.
Entity Type:Organization
Organization Name:EASTER SEALS FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RIKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-881-2822
Mailing Address - Street 1:2010 CROSBY WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4119
Mailing Address - Country:US
Mailing Address - Phone:407-629-7881
Mailing Address - Fax:
Practice Address - Street 1:2002 NW 36TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-2493
Practice Address - Country:US
Practice Address - Phone:352-377-7708
Practice Address - Fax:352-337-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113301000Medicaid