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General NPI Number Information
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NPI Number | 1912308990
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Entity Type | Organization
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Legal Business Name | OWNER BUILDER ASSISTANCE CORP
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 2357 SW ANTIQUERA ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-2436
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Country | US
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Telephone | 561-339-9575
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Fax |
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Provider Business Mailing Address
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Address Line | 2357 SW ANTIQUERA ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-2436
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Country | US
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Telephone | 561-339-9575
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Fax | 772-236-9596
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DONALD LEE MALONE
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Credential |
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Telephone | 561-339-9575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | CGC038404
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License Number State | FL
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