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General NPI Number Information
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NPI Number | 1174285480
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Entity Type | Organization
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Legal Business Name | EBANKS RESIDENTIAL SERVICES, LLC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 6833 19TH DR S
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City | LAKE WORTH
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State | FL
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Zip | 33462-4009
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Country | US
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Telephone | 561-459-0578
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Fax | 561-323-2609
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Provider Business Mailing Address
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Address Line | 6833 19TH DR S
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City | LAKE WORTH
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State | FL
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Zip | 33462-4009
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Country | US
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Telephone | 561-459-0578
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Fax | 561-323-2609
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Authorized Official
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Title or Position | OWNER/CEO
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Name | LORNA E EBANKS
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Credential |
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Telephone | 561-459-0578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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