Healthcare Provider Details

I. General information

NPI: 1427373281
Provider Name (Legal Business Name): RAY OF HOPE HEALTHY LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W COMMERCIAL BLVD 25
FT LAUDERDALE FL
33309-3300
US

IV. Provider business mailing address

3601 W COMMERCIAL BLVD 25
FT LAUDERDALE FL
33309-3300
US

V. Phone/Fax

Practice location:
  • Phone: 954-543-4423
  • Fax:
Mailing address:
  • Phone: 954-543-4423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. VENICE S ATKINSON
Title or Position: PRESIDENT
Credential:
Phone: 954-543-4423