NPIMap

Organization Active NPI

Easterseals Northeast Central Florida, Inc.

  • Early Intervention Provider Agency
  • Daytona Beach, FL
National Provider Identifier
1073283347
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Practice address
1219 Dunn Ave
Daytona Beach, FL 32114-2405
Phone
(386) 944-7805
Fax
(386) 258-7677
NPI assigned
Sep 17, 2021
Last updated
Sep 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X NU Primary

Addresses

Primary practice location

1219 Dunn Ave
Daytona Beach, FL 32114-2405

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
012297200MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Easterseals Northeast Central Florida Inc25 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": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1073283347",
    "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": "1219 DUNN AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142405",
            "telephone_number": "386-944-7805",
            "fax_number": "386-258-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-01",
        "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"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012297200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.