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General NPI Number Information
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NPI Number | 1942616685
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Entity Type | Organization
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Legal Business Name | EL SHADDIA SERVICES, INC.
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 1206 N BUENA VISTA AVE
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City | ORLANDO
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State | FL
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Zip | 32818-6812
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Country | US
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Telephone | 407-294-3551
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Fax | 407-294-7398
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Provider Business Mailing Address
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Address Line | 1206 N. BUENA VISTA AVE
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City | ORLANDO
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State | FL
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Zip | 32818
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Country | US
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Telephone | 407-294-3551
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Fax | 407-294-7398
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL ROZIER
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Credential |
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Telephone | 407-294-3551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 692618598
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 692618596
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 233636
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License Number State | FL
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