Healthcare Provider Details

I. General information

NPI: 1396488771
Provider Name (Legal Business Name): WPB SELECT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 VISTA PKWY STE VO4048
WEST PALM BEACH FL
33411-2706
US

IV. Provider business mailing address

2101 VISTA PKWY STE VO4048
WEST PALM BEACH FL
33411-2706
US

V. Phone/Fax

Practice location:
  • Phone: 561-334-7431
  • Fax:
Mailing address:
  • Phone: 561-334-7431
  • Fax:

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: GREDELINE NHOMME JEUDY
Title or Position: PRESIDENT
Credential:
Phone: 561-334-7431