Healthcare Provider Details

I. General information

NPI: 1407618515
Provider Name (Legal Business Name): ELDER EMBRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6818 SW 9TH ST
PEMBROKE PINES FL
33023-1629
US

IV. Provider business mailing address

6818 SW 9TH ST
PEMBROKE PINES FL
33023-1629
US

V. Phone/Fax

Practice location:
  • Phone: 954-815-1192
  • Fax:
Mailing address:
  • Phone: 954-815-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSELINE LOUIS XVI
Title or Position: DIRECTOR
Credential:
Phone: 954-815-1192