Healthcare Provider Details

I. General information

NPI: 1962337816
Provider Name (Legal Business Name): FOUR CORNERS NURSING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 NW 53RD ST # 22
BOCA RATON FL
33487-8235
US

IV. Provider business mailing address

621 NW 53RD ST # 22
BOCA RATON FL
33487-8235
US

V. Phone/Fax

Practice location:
  • Phone: 561-823-6940
  • Fax: 954-333-6198
Mailing address:
  • Phone: 561-823-6940
  • Fax: 954-333-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MISS NICOLA WEBB
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-661-9741