Healthcare Provider Details

I. General information

NPI: 1255757415
Provider Name (Legal Business Name): NUESTRA CASA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 N A ST
LAKE WORTH FL
33460-6002
US

IV. Provider business mailing address

1906 N A ST
LAKE WORTH FL
33460-6002
US

V. Phone/Fax

Practice location:
  • Phone: 561-252-6399
  • Fax:
Mailing address:
  • Phone: 561-252-6399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAL11471
License Number StateFL

VIII. Authorized Official

Name: CONRADO BARRIO
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-252-6399