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NPI Code Detail

MEDICARE: STAYWELL LLC

MEDICARE: STAYWELL 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
1302R00000XHealth Maintenance OrganizationMA60818FL
2302R00000XHealth Maintenance OrganizationAP2024FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11578637948OTHERFLAPOMD
21972898989OTHERFLLMT

General Provider Information

NPI Number : 1609280858
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAYWELL LLC
Provider Business Mailing Address
First Line : 9769 ARBOR OAKS LN
Second Line : 204
City : BOCA RATON
State : FL
Zip : 33428-2212
Country : US
Telephone Number : 561-303-8903
Fax Number :
Provider Business Practice Location Address
First Line : 5300 W 16TH AVE
Second Line : 106
City : HIALEAH
State : FL
Zip : 33012-2104
Country : US
Telephone Number : 561-303-8903
Fax Number :
Authorized Official
Title or Position : OWNER
Name : TERESA CRUZ
Credential : LMT
Telephone Number : 561-303-8903
Provider Enumeration Date : 06/16/2014
Last Update Date : 06/16/2014

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Directions to “STAYWELL LLC ” Practice Location

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