Florida Lions Conklin CTRS for the Blind

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

FLORIDA LIONS CONKLIN CTRS FOR THE BLIND

Practice address

405 White St
Daytona Beach, FL 32114-2925

Phone

(386) 258-3441

Fax

(386) 258-1155

NPI assigned

Jun 4, 2013

Last updated

Jun 4, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Robert T Kelly, CRC

Title

Executive Director

Phone

(386) 258-3441

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370304000000",
    "number": "1831536515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 WHITE ST",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142925",
            "telephone_number": "386-258-3441",
            "fax_number": "386-258-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 WHITE ST",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142925",
            "telephone_number": "386-258-3441",
            "fax_number": "386-258-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA LIONS CONKLIN CTRS FOR THE BLIND",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-04",
        "last_updated": "2013-06-04",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "386-258-3441",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRC"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "673361196",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099870202",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florida Health Care Plan Inc
• Florida Health Care Plan, Inc (Florida Health Care Plans Inc.)
• Florida Health Care Plans Inc (Florida Health Care Plan Pharmacy)
• Florida Home Medical Equipment, Inc (Atenda Home Medical Equipment)
• Florida Hospital Healthcare Partners, Inc
• Florida Mentor
• Florida Oncology Network PA
• Florida Oral & Facial Surgical Associates PA
• Florida Psychiatry & Counseling LLC
• Florida State Hearing AIDS Inc

• Early Intervention Provider Agency in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Early Intervention Provider Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; 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.