Healthcare Provider Details

I. General information

NPI: 1316140254
Provider Name (Legal Business Name): BOCA RATON COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9291 GLADES RD
BOCA RATON FL
33434-3959
US

IV. Provider business mailing address

9598 PARKVIEW AVE
BOCA RATON FL
33428-2915
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License NumberPT21139
License Number StateFL

VIII. Authorized Official

Name: MRS. LORIE DEJONG
Title or Position: SUPERVISOR PHYSICAL THERAPIST
Credential:
Phone: 561-955-5437