Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE WALLENS (ACCOUNTING MANAGER)
(386) 255-4568
Entity
Organization
Contact information
Practice address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(386) 944-7805
(386) 258-7677
Mailing address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(386) 944-7805
(386) 258-7677
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012297200
—
FL
Enumeration date
09/17/2021
Last updated
09/17/2021
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