NPIMap

Organization Active NPI

Eckerd Youth Alternatives

Doing business as Eckerd Connects

  • Psychiatric Residential Treatment Facility
  • Boomer, NC
National Provider Identifier
1336218486
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
Legal business name
ECKERD YOUTH ALTERNATIVES
Doing business as
Eckerd Connects
Practice address
4654 High Rock Rd
Boomer, NC 28606-9109
Phone
(336) 921-3300
Fax
(336) 921-4320
NPI assigned
Nov 6, 2006
Last updated
Nov 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2019

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X NU Primary
Psychologist 103T00000X NU

Addresses

Primary practice location

4654 High Rock Rd
Boomer, NC 28606-9109

Mailing address

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

Other names 1

  • Eckerd Connects Doing business as

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": "1574208000000",
    "number": "1336218486",
    "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": "4654 HIGH ROCK RD",
            "city": "BOOMER",
            "state": "NC",
            "postal_code": "286069109",
            "telephone_number": "336-921-3300",
            "fax_number": "336-921-4320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECKERD YOUTH ALTERNATIVES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2019-11-20",
        "status": "A",
        "authorized_official_last_name": "STROEBEL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "727-461-2990"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eckerd Connects",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eckerd Connects",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boomer, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.