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Organization
EBEN-EZER GROUP HOME
Active
Organization
EBEN-EZER GROUP HOME
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EVELINE CHARLES NURSING ASSISTANCE (ADMINISTRATOR/OWNER)
(772) 240-6636
Entity
Organization
Contact information
Practice address
1688 SW BURLINGTON ST, PORT ST LUCIE, FL 34984-3559
(772) 240-6636
(772) 249-7004
Mailing address
1688 SW BURLINGTON ST, PORT ST LUCIE, FL 34984-3559
(772) 240-6636
(772) 249-7004
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
151427
FL
Other
Enumeration date
05/12/2011
Last updated
05/12/2011
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