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General NPI Number Information
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NPI Number | 1366076093
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Entity Type | Organization
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Legal Business Name | ESTERLYN'S HOUSE INC
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 1200 BRICKELL AVE STE 1950
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City | MIAMI
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State | FL
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Zip | 33131-3298
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Country | US
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Telephone | 504-756-1795
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 BRICKELL AVE STE 1950
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City | MIAMI
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State | FL
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Zip | 33131-3298
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. EMRON O WALWYN SR.
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Credential | MD
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Telephone | 504-756-1795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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