Provider Demographics
NPI:1992862809
Name:HOME MAJIC COMPANION SERVICES
Entity Type:Organization
Organization Name:HOME MAJIC COMPANION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-495-4221
Mailing Address - Street 1:2106 W TWO LAKES RD
Mailing Address - Street 2:STE M-6
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-7625
Mailing Address - Country:US
Mailing Address - Phone:813-495-4221
Mailing Address - Fax:
Practice Address - Street 1:2106 W TWO LAKES RD
Practice Address - Street 2:STE M-6
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-7625
Practice Address - Country:US
Practice Address - Phone:813-495-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229477251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services