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General NPI Number Information
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NPI Number | 1912308966
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Entity Type | Organization
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Legal Business Name | SEGULAH, INC.
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 2107 COUNTRY SIDE DR
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City | APOPKA
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State | FL
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Zip | 32712-2069
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Country | US
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Telephone | 321-229-4168
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Fax | 407-814-3153
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Provider Business Mailing Address
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Address Line | 2107 COUNTRY SIDE DR
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City | APOPKA
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State | FL
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Zip | 32712-2069
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Country | US
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Telephone | 321-229-4168
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Fax | 407-814-3153
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ERNESTO MARIQUIT
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Credential | RPT
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Telephone | 321-229-4168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | PT5636
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PT5636
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License Number State | FL
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