1760515977 NPI number — PRESCRIBED PEDIATRIC EXTENDED CARE, INC

Table of content: (NPI 1760515977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760515977 NPI number — PRESCRIBED PEDIATRIC EXTENDED CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESCRIBED PEDIATRIC EXTENDED CARE, INC
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:
PEDIATRIC HEALTH CHOICE
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:
1760515977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8509 BENJAMIN ROAD
Provider Second Line Business Mailing Address:
SUITE A D
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33634-1224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-880-0220
Provider Business Mailing Address Fax Number:
813-880-0221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2355 DRUSILLA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-231-5880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TOSTI
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
813-880-0320

Provider Taxonomy Codes

  • Taxonomy code: 261QM3000X , with the licence number:  6009096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X , with the licence number: 60080968 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X , with the licence number: 60080972 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X , with the licence number: 60080962 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X , with the licence number: 60080977 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X , with the licence number: 6006096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X , with the licence number: 60080966 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X , with the licence number: 6003096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X , with the licence number: 60080982 , 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: 300003600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300003605 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300003603 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 650311001 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880567906 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880567901 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300003606 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880567903 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880567907 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 882377400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240005700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300003604 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880567900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880567905 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240012000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300047800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300256000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300256001 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880567902 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880567904 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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