Healthcare Provider Details

I. General information

NPI: 1710404249
Provider Name (Legal Business Name): EMILIA'S DIRECT CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 E COLONIAL DR RM 118
ORLANDO FL
32803
US

IV. Provider business mailing address

3218 E COLONIAL DR RM 118
ORLANDO FL
32803-5179
US

V. Phone/Fax

Practice location:
  • Phone: 407-779-6708
  • Fax:
Mailing address:
  • Phone: 407-779-6708
  • Fax: 407-605-2753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: JULIE TIBAUD
Title or Position: OWNER
Credential:
Phone: 407-779-6708