Provider Demographics
NPI:1720050644
Name:BREEZEMONTE HOMES, INC.
Entity Type:Organization
Organization Name:BREEZEMONTE HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MENEFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-622-8804
Mailing Address - Street 1:8246 LUCAYA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-6677
Mailing Address - Country:US
Mailing Address - Phone:904-622-8804
Mailing Address - Fax:
Practice Address - Street 1:8246 LUCAYA CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-6677
Practice Address - Country:US
Practice Address - Phone:904-622-8804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL673902496251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL673902496Medicaid