Individual provider · NPI-1

Ishmael Bougouneau

Home Health · Orlando, FL

NPI number1467998930

StatusActive

Last updated in NPPESJan 9, 2017

Details

NPI: 1467998930
Entity type: Individual (NPI-1)
Name: Ishmael Bougouneau
Sex: Female
Sole proprietor: Yes
Enumeration date: Jan 9, 2017
Last updated: Jan 9, 2017

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
251E00000X	Home Health	–	FL	Yes
251C00000X	Day Training, Developmentally Disabled Services	–	–
253Z00000X	In Home Supportive Care	–	FL
320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	–	FL
385HR2060X	Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child	–	–

Practice location

2059 Veranda Cir Bldg J
Orlando, FL 32808-4861

Phone 321-914-7628

Mailing address

2059 Veranda Cir Bldg J
Orlando, FL 32808-4861

Phone 321-914-7628

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