Provider Demographics
NPI:1285914150
Name:EPCA, INC
Entity type:Organization
Organization Name:EPCA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-375-3377
Mailing Address - Street 1:5207 MASON DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:FL
Mailing Address - Zip Code:33834-5095
Mailing Address - Country:US
Mailing Address - Phone:863-375-3377
Mailing Address - Fax:863-375-2474
Practice Address - Street 1:5207 MASON DIXON AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:FL
Practice Address - Zip Code:33834-5095
Practice Address - Country:US
Practice Address - Phone:863-375-3377
Practice Address - Fax:863-375-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A261Q00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder