Provider Demographics
NPI:1912308966
Name:SEGULAH, INC.
Entity type:Organization
Organization Name:SEGULAH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIQUIT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:321-229-4168
Mailing Address - Street 1:2107 COUNTRY SIDE DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2069
Mailing Address - Country:US
Mailing Address - Phone:321-229-4168
Mailing Address - Fax:407-814-3153
Practice Address - Street 1:2107 COUNTRY SIDE DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2069
Practice Address - Country:US
Practice Address - Phone:321-229-4168
Practice Address - Fax:407-814-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5636320700000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities