=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124947544
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SJW HOMECARE SERVICE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2026
-----------------------------------------------------
Last Update Date | 07/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2251 OSHKOSH CT
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32818-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-583-9447
-----------------------------------------------------
Fax | 407-601-6992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2251 OSHKOSH CT
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32818-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-583-9447
-----------------------------------------------------
Fax | 407-601-6992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | YOLETTE PACIUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-583-9447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------