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General NPI Number Information
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NPI Number | 1780037390
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Entity Type | Organization
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Legal Business Name | OUR HOUSE WON
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 4215 ROBBINS AVE
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City | ORLANDO
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State | FL
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Zip | 32808-2108
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Country | US
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Telephone | 407-929-4895
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 ROBBINS AVE
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City | ORLANDO
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State | FL
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Zip | 32808-2108
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Country | US
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Telephone | 407-929-4895
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DOROTHY JACKSON
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Credential |
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Telephone | 407-929-4895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 016385700
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License Number State | FL
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