1245370626 NPI number — ECCI, LLC

Table of content: (NPI 1245370626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245370626 NPI number — ECCI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ECCI, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTRAL FLORIDA CONTRACT INDUSTRIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245370626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1890 STATE ROAD 436
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-2285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-645-3211
Provider Business Mailing Address Fax Number:
407-628-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 S LAKE DESTINY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32810-6238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-660-8330
Provider Business Practice Location Address Fax Number:
407-660-1614
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-645-3211

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  F593197713001 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 670938998 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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