Healthcare Provider Details

I. General information

NPI: 1134126071
Provider Name (Legal Business Name): HOSPICE BY THE SEA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 W PALMETTO PARK RD
BOCA RATON FL
33486-3307
US

IV. Provider business mailing address

1531 W PALMETTO PARK RD
BOCA RATON FL
33486-3307
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-5031
  • Fax: 561-373-7137
Mailing address:
  • Phone: 561-395-5031
  • Fax: 561-373-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number5011096
License Number StateFL

VIII. Authorized Official

Name: JACOB J SPRUIT JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 561-416-5014