Provider Demographics
NPI:1881099224
Name:ELIJAH NETWORK FAMILY AND COMMUNITY ALLIANCE, INC.
Entity type:Organization
Organization Name:ELIJAH NETWORK FAMILY AND COMMUNITY ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPP
Authorized Official - Phone:786-253-6921
Mailing Address - Street 1:PO BOX 700006
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-0006
Mailing Address - Country:US
Mailing Address - Phone:786-253-6921
Mailing Address - Fax:786-345-5918
Practice Address - Street 1:27500 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8217
Practice Address - Country:US
Practice Address - Phone:786-253-6921
Practice Address - Fax:786-345-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency