Provider Demographics
NPI:1790430874
Name:HOUSE OF ESTHER FAMILY CARE & SERVICES, LLC
Entity Type:Organization
Organization Name:HOUSE OF ESTHER FAMILY CARE & SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-244-2547
Mailing Address - Street 1:1227 RUSHGROVE CIR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-4950
Mailing Address - Country:US
Mailing Address - Phone:813-244-2547
Mailing Address - Fax:
Practice Address - Street 1:1227 RUSHGROVE CIR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:FL
Practice Address - Zip Code:33527-4950
Practice Address - Country:US
Practice Address - Phone:813-244-2547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No177F00000XOther Service ProvidersLodging
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL22000062395OtherDOCUMENT ID