Provider Demographics
NPI:1588060529
Name:PRESCRIBED PEDIATRIC EXTENDED CARE, INC
Entity type:Organization
Organization Name:PRESCRIBED PEDIATRIC EXTENDED CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-870-0000
Mailing Address - Street 1:8509 BENJAMIN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1224
Mailing Address - Country:US
Mailing Address - Phone:813-880-0320
Mailing Address - Fax:
Practice Address - Street 1:8509 BENJAMIN RD
Practice Address - Street 2:SUITE D
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1224
Practice Address - Country:US
Practice Address - Phone:813-880-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880567902Medicaid
FL880567903Medicaid
FL880567905Medicaid
FL880567906Medicaid
FL300256001Medicaid
FL880567904Medicaid
FL880567900Medicaid
FL880567901Medicaid
FL882377400Medicaid
FL880567907Medicaid
FL880567908Medicaid