Healthcare Provider Details

I. General information

NPI: 1043346935
Provider Name (Legal Business Name): BOYNTON BEACH AL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S CONGRESS AVE
BOYNTON BEACH FL
33426-6381
US

IV. Provider business mailing address

1425 S CONGRESS AVE
BOYNTON BEACH FL
33426-6381
US

V. Phone/Fax

Practice location:
  • Phone: 561-369-7919
  • Fax: 561-369-3413
Mailing address:
  • Phone: 561-369-7919
  • Fax: 561-369-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1616096
License Number StateFL

VIII. Authorized Official

Name: PATRICIA ANN BRIGGS
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 561-369-7919