Healthcare Provider Details

I. General information

NPI: 1679667158
Provider Name (Legal Business Name): DOS OF PALM BEACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 54 STREET
WEST PALM BEACH FL
33407-2419
US

IV. Provider business mailing address

1101 54 STREET
WEST PALM BEACH FL
33407-2419
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-8401
  • Fax: 561-842-4658
Mailing address:
  • Phone: 561-844-8401
  • Fax: 561-842-4658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1266096
License Number StateFL

VIII. Authorized Official

Name: MR. JORGE R HERNANDO
Title or Position: CFO
Credential:
Phone: 561-844-8401