Healthcare Provider Details

I. General information

NPI: 1558663161
Provider Name (Legal Business Name): FAMILY CARE NURSES REG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4047 OKEECHOBEE BLVD #124
WEST PALM BCH FL
33409
US

IV. Provider business mailing address

4047 OKEECHOBEE BLVD #124
WEST PALM BCH FL
33409
US

V. Phone/Fax

Practice location:
  • Phone: 561-686-4552
  • Fax: 561-686-4528
Mailing address:
  • Phone: 561-686-4552
  • Fax: 561-686-4528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number30211111
License Number StateFL

VIII. Authorized Official

Name: MRS. CARMEN IULDA JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-686-4552