Provider Demographics
NPI:1447083118
Name:EASTER SEALS FLORIDA, INC.
Entity type:Organization
Organization Name:EASTER SEALS FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RIKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-287-5185
Mailing Address - Street 1:2010 CROSBY WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4119
Mailing Address - Country:US
Mailing Address - Phone:407-629-7881
Mailing Address - Fax:407-629-4754
Practice Address - Street 1:31600 CAMP CHALLENGE RD
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-9558
Practice Address - Country:US
Practice Address - Phone:352-383-4711
Practice Address - Fax:352-383-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123674700Medicaid