Healthcare Provider Details

I. General information

NPI: 1497928071
Provider Name (Legal Business Name): RGR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 W. OAKLAND PARK BLVD. SUITE 215
FT. LAUDERDALE FL
33311-1350
US

IV. Provider business mailing address

2880 W. OAKLAND PARK BLVD. SUITE 215
FT. LAUDERDALE FL
33311-1350
US

V. Phone/Fax

Practice location:
  • Phone: 954-677-2700
  • Fax: 954-677-2800
Mailing address:
  • Phone: 954-677-2700
  • Fax: 954-677-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299993020
License Number StateFL

VIII. Authorized Official

Name: MR. GREGORY G ROY
Title or Position: PRESIDENT
Credential:
Phone: 954-677-2700