Provider Demographics
NPI:1629526074
Name:EAKENS GROUP HOME
Entity type:Organization
Organization Name:EAKENS GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:RONEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-727-0118
Mailing Address - Street 1:8402 RIO BRAVO CT
Mailing Address - Street 2:3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-7083
Mailing Address - Country:US
Mailing Address - Phone:832-727-0118
Mailing Address - Fax:832-727-0118
Practice Address - Street 1:8402 RIO BRAVO CT
Practice Address - Street 2:3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7083
Practice Address - Country:US
Practice Address - Phone:832-727-0118
Practice Address - Fax:832-727-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5211100311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home