NPIMap

Organization Active NPI

Easterseals Northeast Central Florida, Inc.

  • Community/Behavioral Health Agency
  • Palm Coast, FL
National Provider Identifier
1003517715
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Practice address
160 Cypress Point Pkwy Ste B205
Palm Coast, FL 32164-8437
Phone
(386) 878-4220
Fax
(386) 258-7677
NPI assigned
Mar 10, 2023
Last updated
Jul 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Michele Wallens
Title
Accounting Manager
Phone
(386) 255-4568

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2080P0006X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

160 Cypress Point Pkwy Ste B205
Palm Coast, FL 32164-8437

Mailing address

1219 Dunn Ave
Daytona Beach, FL 32114-2405
Phone (386) 944-7805

National Provider Directory

National Provider Directory
Tax ID family
Easter Seal Society25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1003517715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 DUNN AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142405",
            "telephone_number": "386-944-7805",
            "fax_number": "386-258-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 CYPRESS POINT PKWY STE B205",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321648437",
            "telephone_number": "386-878-4220",
            "fax_number": "386-258-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-10",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "WALLENS",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "ACCOUNTING MANAGER",
        "authorized_official_telephone_number": "386-255-4568",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.