Healthcare Provider Details

I. General information

NPI: 1174909584
Provider Name (Legal Business Name): EVELYNE PIARD GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 BAHAMA AVE S
LEHIGH ACRES FL
33974-9791
US

IV. Provider business mailing address

672 KINGSBURY ST E
LEHIGH ACRES FL
33974-0731
US

V. Phone/Fax

Practice location:
  • Phone: 239-368-2636
  • Fax:
Mailing address:
  • Phone: 781-307-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: EVELYNE PIARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-307-2347