Healthcare Provider Details

I. General information

NPI: 1043488869
Provider Name (Legal Business Name): BOCA RIDGE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22835 VAN DYKE AVE
WARREN MI
48089-2356
US

IV. Provider business mailing address

22835 VAN DYKE AVE
WARREN MI
48089-2356
US

V. Phone/Fax

Practice location:
  • Phone: 586-757-6505
  • Fax: 586-757-7785
Mailing address:
  • Phone: 586-757-6505
  • Fax: 586-757-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW MERVIN EFRUSY
Title or Position: CHIEF RPH/OWNER
Credential: RPH
Phone: 586-757-6505