Provider Demographics
NPI:1861074726
Name:PRESCRIBED PEDIATRIC EXTENDED CARE, INC
Entity type:Organization
Organization Name:PRESCRIBED PEDIATRIC EXTENDED CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TOSTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-880-0320
Mailing Address - Street 1:8509 BENJAMIN RD STE D
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1224
Mailing Address - Country:US
Mailing Address - Phone:813-769-5358
Mailing Address - Fax:
Practice Address - Street 1:125 EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1180
Practice Address - Country:US
Practice Address - Phone:386-253-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880567903Medicaid