Individual
ISHMAEL BOUGOUNEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2059 VERANDA CIR BLDG J, ORLANDO, FL 32808-4861
(321) 914-7628
Mailing address
2059 VERANDA CIR BLDG J, ORLANDO, FL 32808-4861
(321) 914-7628
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
—
FL
253Z00000X
In Home Supportive Care Agency
—
FL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
01/09/2017
Last updated
01/09/2017
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