Healthcare Provider Details

I. General information

NPI: 1629065933
Provider Name (Legal Business Name): DELRAY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 LINTON BLVD
DELRAY BEACH FL
33484-6512
US

IV. Provider business mailing address

5430 LINTON BLVD
DELRAY BEACH FL
33484-6512
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-3188
  • Fax: 561-495-3190
Mailing address:
  • Phone: 561-495-3188
  • Fax: 561-495-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF12300962
License Number StateFL

VIII. Authorized Official

Name: MR. NELSON ROBAINA JR.
Title or Position: REINBURSEMENT
Credential:
Phone: 605-864-9191