Organization
ECKERD YOUTH ALTERNATIVES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE STROEBEL (CFO)
(727) 461-2990
Entity
Organization
Contact information
Practice address
500 E KU SUMEE DR, CANDOR, NC 27229-9058
(910) 974-4183
(910) 974-7310
Mailing address
100 STARCREST DR, CLEARWATER, FL 33765-3224
(727) 461-2990
(727) 216-0055
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
901MXH
—
SC
Enumeration date
11/06/2006
Last updated
09/11/2019
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