Healthcare Provider Details

I. General information

NPI: 1225465594
Provider Name (Legal Business Name): SENIORBRIDGE-FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8751 W BROWARD BLVD STE 200
PLANTATION FL
33324-2630
US

IV. Provider business mailing address

845 3RD AVE FL 7
NEW YORK NY
10022-6629
US

V. Phone/Fax

Practice location:
  • Phone: 954-423-2217
  • Fax: 954-475-8071
Mailing address:
  • Phone: 212-994-6100
  • Fax: 212-994-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number21033096
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number21033096
License Number StateFL

VIII. Authorized Official

Name: MR. ERIC C RACKOW
Title or Position: PRESIDENT AND CEO
Credential: M.D.
Phone: 212-994-6108