Healthcare Provider Details

I. General information

NPI: 1427620202
Provider Name (Legal Business Name): BOCA REGENTS OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 VERDE TRL
BOCA RATON FL
33433-7702
US

IV. Provider business mailing address

6363 VERDE TRL
BOCA RATON FL
33433-7702
US

V. Phone/Fax

Practice location:
  • Phone: 561-483-9282
  • Fax: 561-226-1890
Mailing address:
  • Phone: 561-483-9282
  • Fax: 561-226-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK FRIEDMAN
Title or Position: MANAGER
Credential:
Phone: 201-731-1700