NPIMap

Organization Active NPI

Easterseals Northeast Central Florida, Inc.

  • Behavior Analyst
  • Bunnell, FL
National Provider Identifier
1831963131
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Practice address
3389 N State St Unit 1
Bunnell, FL 32110-4340
Phone
(386) 255-4568
Fax
(386) 258-7677
NPI assigned
Nov 8, 2023
Last updated
Nov 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

3389 N State St Unit 1
Bunnell, FL 32110-4340

Mailing address

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

Other names 1

  • #MIP Other name

National Provider Directory

National Provider Directory
Tax ID family
Susan M Rohm25 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": "1699401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699401600000",
    "number": "1831963131",
    "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": "3389 N STATE ST UNIT 1",
            "city": "BUNNELL",
            "state": "FL",
            "postal_code": "321104340",
            "telephone_number": "386-255-4568",
            "fax_number": "386-258-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-08",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "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": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "#MIP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bunnell, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.