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General NPI Number Information
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NPI Number | 1104313790
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Entity Type | Organization
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Legal Business Name | EVELYN'S HOME ASSISTED LIVING LLC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2119 BEACON LANDING CIR
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City | ORLANDO
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State | FL
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Zip | 32824-4374
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Country | US
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Telephone | 407-497-1243
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Fax | 407-888-9121
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Provider Business Mailing Address
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Address Line | 2119 BEACON LANDING CIR
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City | ORLANDO
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State | FL
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Zip | 32824-4374
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Country | US
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Telephone | 407-497-1243
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Fax | 407-888-9121
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | FLORENCE WOBERAERE EJIOWHOR
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Credential | RN
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Telephone | 407-497-1243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL13064
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License Number State | FL
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