Provider Demographics
NPI:1063811545
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:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPP
Authorized Official - Phone:786-253-6921
Mailing Address - Street 1:27500 OLD DIXIE HWY
Mailing Address - Street 2:#7
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8217
Mailing Address - Country:US
Mailing Address - Phone:786-253-6921
Mailing Address - Fax:
Practice Address - Street 1:27500 OLD DIXIE HWY
Practice Address - Street 2:#7
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency