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General NPI Number Information
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NPI Number | 1982126710
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Entity Type | Organization
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Legal Business Name | EMERALD COAST COMPANION SERVICES, LLC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7120 HEATHER OAKS DR
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City | PENSACOLA
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State | FL
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Zip | 32506-3893
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Country | US
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Telephone | 209-688-8701
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Fax |
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Provider Business Mailing Address
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Address Line | 7120 HEATHER OAKS DR
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City | PENSACOLA
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State | FL
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Zip | 32506-3893
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Country | US
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Telephone | 209-688-8701
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ESTELLETTA WASHINGTON
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Credential |
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Telephone | 209-688-8701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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