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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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