Organization
PEDIATRIC HEALTH CHOICE
Active
Parent organization
PRESCRIBED PEDIATRIC EXTENDED CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRESCRIBED PEDIATRIC EXTENDED CARE
Authorized official
DEBORAH FRAZE (EXECUTIVE VP)
(813) 880-0320
Entity
Organization
Contact information
Practice address
3110 75TH ST N, ST PETERSBURG, FL 33710-2326
(727) 347-0010
Mailing address
8509 BENJAMIN RD, SUITE D, TAMPA, FL 33634-1224
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
882377400
—
FL
Enumeration date
11/20/2014
Last updated
03/28/2022
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