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General NPI Number Information
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NPI Number | 1649343468
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Entity Type | Organization
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Legal Business Name | ELQUANAH GROUP HOMES INC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 955 TUSKAWILLA RD
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City | WINTER SPRINGS
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State | FL
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Zip | 32708
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Country | US
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Telephone | 407-699-1315
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Fax | 407-699-1735
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Provider Business Mailing Address
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Address Line | 955 TUSKAWILLA RD
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City | WINTER SPRINGS
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State | FL
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Zip | 32708
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Country | US
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Telephone | 407-699-1315
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Fax | 407-699-1735
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. BRENDA L GREENE
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Credential |
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Telephone | 407-760-4283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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