Provider Demographics
NPI:1851815849
Name:EL-SHADDAI & SONS MAINTENANCE LLC
Entity Type:Organization
Organization Name:EL-SHADDAI & SONS MAINTENANCE LLC
Other - Org Name:EL-SHADDAI & SONS MAINTENANCE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSHAWN
Authorized Official - Middle Name:FELISHA
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-208-4334
Mailing Address - Street 1:209 FACTORY ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-4608
Mailing Address - Country:US
Mailing Address - Phone:1321-208-4334
Mailing Address - Fax:
Practice Address - Street 1:209 FACTORY ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922
Practice Address - Country:US
Practice Address - Phone:321-208-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL-SHADDAI & SONS MAINTENANCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid