Provider Demographics
NPI:1538333422
Name:VURSATYLE YOUTH SOLUTIONS
Entity type:Organization
Organization Name:VURSATYLE YOUTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:239-297-8301
Mailing Address - Street 1:1242 SW PINE ISLAND RD
Mailing Address - Street 2:SUITE 42-285
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2120
Mailing Address - Country:US
Mailing Address - Phone:239-297-8301
Mailing Address - Fax:
Practice Address - Street 1:1242 SW PINE ISLAND RD
Practice Address - Street 2:SUITE 42-285
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2120
Practice Address - Country:US
Practice Address - Phone:239-297-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689849196Medicaid