MEDICARE: POPO POWERHOUSE GROUP HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1265378970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POPO POWERHOUSE GROUP HOME LLC

Provider Business Mailing Address
First Line	:	5860 WESTFALL RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-6731
Country	:	US
Telephone Number	:	561-377-6289
Fax Number	:

Provider Business Practice Location Address
First Line	:	5860 WESTFALL RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-6731
Country	:	US
Telephone Number	:	561-377-6289
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	JEAN HENRY HENRY BASTIEN
Credential	:
Telephone Number	:	561-377-6289

Provider Enumeration Date	:	04/25/2026
Last Update Date	:	04/25/2026

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