Provider Demographics
NPI:1366993404
Name:STEVE EWALD
Entity type:Organization
Organization Name:STEVE EWALD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:EWALD
Authorized Official - Suffix:
Authorized Official - Credentials:BS/MS
Authorized Official - Phone:321-505-7620
Mailing Address - Street 1:5595 WILLOUGHBY DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-2822
Mailing Address - Country:US
Mailing Address - Phone:321-505-7620
Mailing Address - Fax:
Practice Address - Street 1:5595 WILLOUGHBY DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-2822
Practice Address - Country:US
Practice Address - Phone:321-505-7620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities