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General NPI Number Information
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NPI Number | 1043510928
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Entity Type | Organization
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Legal Business Name | PACHOT GROUP HOME INC
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 3905 TIMBER TRL
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City | ORLANDO
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State | FL
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Zip | 32808-2344
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Country | US
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Telephone | 407-292-9031
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Fax | 407-656-8484
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Provider Business Mailing Address
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Address Line | 13431 ZORI LN
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City | WINDERMERE
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State | FL
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Zip | 34786-7315
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Country | US
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Telephone | 407-292-9031
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Fax | 407-656-8484
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. JACQUELINE ROSA
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Credential |
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Telephone | 407-292-9031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 7G319 A/C
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License Number State | FL
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