Provider Demographics
NPI:1942616685
Name:EL SHADDIA SERVICES, INC.
Entity Type:Organization
Organization Name:EL SHADDIA SERVICES, INC.
Other - Org Name:EL SHADDIA SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-294-3551
Mailing Address - Street 1:1206 N. BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818
Mailing Address - Country:US
Mailing Address - Phone:407-294-3551
Mailing Address - Fax:407-294-7398
Practice Address - Street 1:1206 N BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6812
Practice Address - Country:US
Practice Address - Phone:407-294-3551
Practice Address - Fax:407-294-7398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233636253Z00000X
FL692618598347C00000X
FL692618596385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child