# EAGLE EYE GROUP HOME, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EAGLE EYE GROUP HOME, INC.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336894393
- **Authorized official:** PAULETTE ANNMARIE ANNIKEY MEDICAID PROVIDER (CEO)
- **Authorized official phone:** (321) 978-6509

## Contact information

- **Practice address:** 415 EAGLE EYE GROUP HOME, INC, KISSIMMEE, FL 34759
- **Practice address phone:** (863) 547-4886
- **Practice address fax:** (863) 547-4993
- **Mailing address:** 415 EAGLE DR, KISSIMMEE, FL 34759-4432
- **Mailing address phone:** (863) 547-4886
- **Mailing address fax:** (863) 547-4993

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 02/18/2022
- **Last updated:** 02/18/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 692345396 | — | FL |