Healthcare Provider Details

I. General information

NPI: 1942616685
Provider Name (Legal Business Name): EL SHADDIA SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 N BUENA VISTA AVE
ORLANDO FL
32818-6812
US

IV. Provider business mailing address

1206 N. BUENA VISTA AVE
ORLANDO FL
32818
US

V. Phone/Fax

Practice location:
  • Phone: 407-294-3551
  • Fax: 407-294-7398
Mailing address:
  • Phone: 407-294-3551
  • Fax: 407-294-7398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number233636
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number692618598
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number692618596
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL ROZIER
Title or Position: PRESIDENT
Credential:
Phone: 407-294-3551