Healthcare Provider Details

I. General information

NPI: 1578974440
Provider Name (Legal Business Name): HALIFAX SENIOR CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 RIDGEWOOD AVE SUITE B
HOLLY HILL FL
32117
US

IV. Provider business mailing address

1515 RIDGEWOOD AVE SUITE B
HOLLY HILL FL
32117
US

V. Phone/Fax

Practice location:
  • Phone: 386-265-1990
  • Fax: 386-310-7916
Mailing address:
  • Phone: 386-265-1990
  • Fax: 386-310-7916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9273
License Number StateFL

VIII. Authorized Official

Name: MR. RYAN KENNEDY
Title or Position: OWNER
Credential:
Phone: 386-265-1990