Eastwinds of Florida Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

AL5405 Issued in FL

Legal business name

EASTWINDS OF FLORIDA INC.

Doing business as

AZALEA MANOR

Practice address

112 12TH Ave N
St Petersburg, FL 33701-1826

Phone

(727) 821-8510

NPI assigned

Oct 24, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Floyd M. McKenzie

Title

Administrator

Phone

(727) 821-8510

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• AZALEA MANOR Doing business as

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471564800000",
    "number": "1386823599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 ROBINHOOD LN",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337646449",
            "telephone_number": "727-821-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 12TH AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337011826",
            "telephone_number": "727-821-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTWINDS OF FLORIDA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2016-08-19",
        "status": "A",
        "authorized_official_last_name": "MCKENZIE",
        "authorized_official_first_name": "FLOYD",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-821-8510",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "AL5405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "687826196",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AZALEA MANOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2016; 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.