Provider Demographics
NPI:1063110559
Name:SHOWBOAT CONSULTING GROUP LLC
Entity type:Organization
Organization Name:SHOWBOAT CONSULTING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:GENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-443-9809
Mailing Address - Street 1:1706B RIDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-4963
Mailing Address - Country:US
Mailing Address - Phone:850-443-9809
Mailing Address - Fax:
Practice Address - Street 1:1706B RIDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-4963
Practice Address - Country:US
Practice Address - Phone:850-443-9809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services