Healthcare Provider Details

I. General information

NPI: 1447713243
Provider Name (Legal Business Name): FLORIDA REACHLINK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 FAU BLVD STE 400
BOCA RATON FL
33431-6489
US

IV. Provider business mailing address

3651 FAU BLVD STE 400
BOCA RATON FL
33431-6489
US

V. Phone/Fax

Practice location:
  • Phone: 561-251-7606
  • Fax:
Mailing address:
  • Phone: 561-251-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES FARESE
Title or Position: CEO
Credential:
Phone: 561-251-7606