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General NPI Number Information
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NPI Number | 1477125516
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Entity Type | Organization
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Legal Business Name | THE HOUSE OF ISRAEL INC
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 4 5TH ST SW
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City | FORT MEADE
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State | FL
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Zip | 33841-3410
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Country | US
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Telephone | 863-712-2774
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Fax | 888-677-8750
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Provider Business Mailing Address
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Address Line | PO BOX 881
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City | FORT MEADE
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State | FL
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Zip | 33841-0881
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Country | US
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Telephone | 863-712-2774
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Fax | 888-677-8750
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MAURICE CAMPBELL
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Credential |
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Telephone | 863-712-2774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 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 #3
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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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 | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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