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General NPI Number Information
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NPI Number | 1629753744
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Entity Type | Organization
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Legal Business Name | EAGER CARE PLACE LLC
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 5920 LONG PEAK DR
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City | ORLANDO
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State | FL
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Zip | 32810-3244
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Country | US
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Telephone | 786-744-0525
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Fax | 407-601-3127
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Provider Business Mailing Address
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Address Line | 1154 E 10TH ST
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City | APOPKA
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State | FL
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Zip | 32703-5405
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Country | US
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Telephone | 786-744-0525
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Fax | 407-601-3127
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Authorized Official
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Title or Position | OWNER
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Name | FABVIENNE SAINT JUSTE
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Credential | LPN
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Telephone | 786-744-0525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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