Healthcare Provider Details

I. General information

NPI: 1932641651
Provider Name (Legal Business Name): PDM ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 LAKE EMERALD DR APT 304
OAKLAND PARK FL
33309-6265
US

IV. Provider business mailing address

117 LAKE EMERALD DR APT 304
OAKLAND PARK FL
33309-6265
US

V. Phone/Fax

Practice location:
  • Phone: 954-547-8510
  • Fax:
Mailing address:
  • Phone: 954-547-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PETAL-DAWN LOUBERT
Title or Position: OWNER
Credential:
Phone: 954-547-8510