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4770 S Ridgewood Ave Port Orange FL 32127-4544 | |
| (386) 416-9767 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 4770 S Ridgewood Ave, Port Orange, Florida |
| Authorized Official Name and Position | Edward Merkle (PRESIDENT) |
| Authorized Official Contact | 3864169767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
313 Cedar Ave New Smyrna Beach FL 32169-2618 Ph: (386) 416-9767 | 4770 S Ridgewood Ave Port Orange FL 32127-4544 Ph: (386) 416-9767 |
| NPI Number | 1871059030 |
|---|---|
| Provider Enumeration Date | 02/13/2019 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Medicare PECOS PAC ID | 4385098177 |
|---|---|
| Medicare Enrollment ID | O20230927003391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871059030 | NPI | - | NPPES |
| 1295077212 | Medicaid | FL |
| Provider Name | Edward Merkle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295077212 PECOS PAC ID: 8820442619 Enrollment ID: I20231221001458 |
| Provider Name | Angela Rae Baldwin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831642032 PECOS PAC ID: 2062856610 Enrollment ID: I20240222000726 |
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