Provider Demographics
NPI:1104263797
Name:ECKERD YOUTH ALTERNATIVES, INC., DBA ECKERD CONNECTS
Entity type:Organization
Organization Name:ECKERD YOUTH ALTERNATIVES, INC., DBA ECKERD CONNECTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-461-2990
Mailing Address - Street 1:100 STARCREST DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3224
Mailing Address - Country:US
Mailing Address - Phone:727-461-2990
Mailing Address - Fax:727-216-0088
Practice Address - Street 1:5350 S WESTERN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4520
Practice Address - Country:US
Practice Address - Phone:405-636-5956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No253J00000XAgenciesFoster Care Agency