NPIMap

Organization Active NPI

Eckerd Youth Alternatives Inc

  • Psychiatric Residential Treatment Facility
  • Candor, NC
National Provider Identifier
1336218429
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
Legal business name
ECKERD YOUTH ALTERNATIVES INC
Practice address
500 E Ku Sumee Dr
Candor, NC 27229-9058
Phone
(910) 974-4183
Fax
(910) 974-7310
NPI assigned
Nov 6, 2006
Last updated
Sep 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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

Authorized official

Name
Nicole Stroebel
Title
Cfo
Phone
(727) 461-2990

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X NU Primary
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

500 E Ku Sumee Dr
Candor, NC 27229-9058

Mailing address

100 Starcrest Dr
Clearwater, FL 33765-3224
Phone (727) 461-2990

Other identifiers 1

IdentifierTypeStateIssuer
901MXHMedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Eckerd Youth Alternatives Inc Dba Eckerd Connects13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568160000000",
    "number": "1336218429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 STARCREST DR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337653224",
            "telephone_number": "727-461-2990",
            "fax_number": "727-216-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E KU SUMEE DR",
            "city": "CANDOR",
            "state": "NC",
            "postal_code": "272299058",
            "telephone_number": "910-974-4183",
            "fax_number": "910-974-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECKERD YOUTH ALTERNATIVES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2019-09-11",
        "status": "A",
        "authorized_official_last_name": "STROEBEL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "727-461-2990"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "901MXH",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Candor, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; 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.