1689035602 NPI number — CHILDREN'S CARE CAMPUS, INC.

Table of content: (NPI 1689035602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689035602 NPI number — CHILDREN'S CARE CAMPUS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S CARE CAMPUS, 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:
Provider Other Organization Name Type Code:
6
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:
1689035602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4448 EDGEWATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32804-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-513-3000
Provider Business Mailing Address Fax Number:
407-515-6537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11251 S ORANGE BLOSSOM TRL
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32837-9297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-513-3000
Provider Business Practice Location Address Fax Number:
407-515-6537
Provider Enumeration Date:
03/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
407-513-3077

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 227900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2279P3900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM3000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 240014603 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com