Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEVERLY JOHNSON (CEO)
(386) 255-4568
Entity
Organization
Contact information
Practice address
650 W NEW YORK AVE, DELAND, FL 32720-5239
(386) 255-4568
(386) 258-7677
Mailing address
1219 DUNN AVE, P.O. BOX 9117, DAYTONA BEACH, FL 32114-2405
(386) 255-4568
(386) 258-7677
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
34167
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8907811 00
—
FL
Enumeration date
02/20/2007
Last updated
04/03/2023
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