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General NPI Number Information
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NPI Number | 1548921281
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Entity Type | Organization
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Legal Business Name | EL SHADDAI CARE FACILITY LLC
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 01/22/2022
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Provider Practice Location Address
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Address Line | 5325 RENOIR DR
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City | ORLANDO
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State | FL
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Zip | 32818-1372
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Country | US
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Telephone | 321-368-0216
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Fax |
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Provider Business Mailing Address
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Address Line | 5325 RENOIR DR
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City | ORLANDO
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State | FL
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Zip | 32818-1372
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Country | US
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Telephone | 321-368-0216
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | YDOPCENE ESTERIL
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Credential |
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Telephone | 321-368-0216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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