Healthcare Provider Details

I. General information

NPI: 1962954263
Provider Name (Legal Business Name): TRANSITIONAL CARE OF SOUTHEAST FLORIDA LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 S ARAGON BLVD UNIT 4
SUNRISE FL
33322-3136
US

IV. Provider business mailing address

7701 S ARAGON BLVD UNIT 4
SUNRISE FL
33322-3136
US

V. Phone/Fax

Practice location:
  • Phone: 954-200-3373
  • Fax:
Mailing address:
  • Phone: 954-200-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MATHEW M NEMBHARD
Title or Position: OWNER
Credential:
Phone: 954-200-3373