Healthcare Provider Details

I. General information

NPI: 1689145492
Provider Name (Legal Business Name): MCREGINALD DENIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6741 W SUNRISE BLVD STE A32
PLANTATION FL
33313-6067
US

IV. Provider business mailing address

500 NE SPANISH RIVER BLVD STE 105C
BOCA RATON FL
33431-4559
US

V. Phone/Fax

Practice location:
  • Phone: 954-908-3802
  • Fax: 561-870-0115
Mailing address:
  • Phone: 561-283-3869
  • Fax: 561-870-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MCREGINALD H DENIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-908-3802