Eben-Ezer Group Home

NPI #1588956320 in Port St Lucie, Florida

Provider Information

NPI Number: 1588956320
Entity Type: Organization
Organization Name: Eben-Ezer Group Home
Primary Specialty: Respite Care - Respite Care, Intellectual and/or Developmental Disabilities, Child
Enumeration Date: May 12, 2011
Last Updated: May 12, 2011

Practice Location

Address: 1688 SW BURLINGTON ST
City: Port St Lucie
State: Florida
ZIP Code: 34984-3559
Phone: (772) 240-6636

Authorized Official

Name: MS. EVELINE CHARLES, NURSING ASSISTANCE
Title: ADMINISTRATOR/OWNER
Phone: (772) 240-6636

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Respite Care - Respite Care, Intellectual and/or Developmental Disabilities, Child — Respite Care, Intellectual and/or Developmental Disabilities, Child	385HR2060X	Primary

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