Eagle Eye Group Home, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

EAGLE EYE GROUP HOME, INC.

Doing business as

Eagle Eye Group Home, Inc.

Practice address

415 Eagle Eye Group Home, Inc
Kissimmee, FL 34759

Phone

(863) 547-4886

Fax

(863) 547-4993

NPI assigned

Feb 18, 2022

Last updated

Feb 18, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paulette Annmarie Annikey, MEDICAID PROVIDERNPI 1124772520

Title

Ceo

Phone

(321) 978-6509

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• EAGLE EYE GROUP HOME, INC. Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paulette Annmarie Annikey

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Kissimmee, FL
  • NPI 1124772520

  Residential Treatment Facility, Intellectual and/Or Developmental Disabilities

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645142400000",
    "number": "1336894393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 EAGLE DR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347594432",
            "telephone_number": "863-547-4886",
            "fax_number": "863-547-4993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 EAGLE EYE GROUP HOME, INC",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34759",
            "telephone_number": "863-547-4886",
            "fax_number": "863-547-4993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE EYE GROUP HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-18",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "ANNIKEY",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_middle_name": "ANNMARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "321-978-6509",
        "authorized_official_credential": "MEDICAID PROVIDER"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "692345396",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAGLE EYE GROUP HOME, INC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.