1881099224 NPI number — ELIJAH NETWORK FAMILY AND COMMUNITY ALLIANCE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881099224 NPI number — ELIJAH NETWORK FAMILY AND COMMUNITY ALLIANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIJAH NETWORK FAMILY AND COMMUNITY ALLIANCE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881099224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33170-0006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-253-6921
Provider Business Mailing Address Fax Number:
786-345-5918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27500 OLD DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMESTEAD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33032-8217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-253-6921
Provider Business Practice Location Address Fax Number:
786-345-5918
Provider Enumeration Date:
10/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WITTE
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
786-253-6921

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com