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General NPI Number Information
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NPI Number | 1881099224
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Entity Type | Organization
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Legal Business Name | ELIJAH NETWORK FAMILY AND COMMUNITY ALLIANCE, INC.
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 27500 OLD DIXIE HWY
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City | HOMESTEAD
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State | FL
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Zip | 33032-8217
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Country | US
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Telephone | 786-253-6921
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Fax | 786-345-5918
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Provider Business Mailing Address
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Address Line | PO BOX 700006
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City | MIAMI
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State | FL
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Zip | 33170-0006
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Country | US
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Telephone | 786-253-6921
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Fax | 786-345-5918
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Authorized Official
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Title or Position | CEO
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Name | KATHLEEN WITTE
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Credential | C.P.P.
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Telephone | 786-253-6921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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