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General NPI Number Information
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NPI Number | 1033682117
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Entity Type | Organization
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Legal Business Name | EJS HOPE CENTER
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 1206 33RD AVE SW
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City | VERO BEACH
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State | FL
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Zip | 32968-5050
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Country | US
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Telephone | 954-647-7807
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Fax | 772-205-2326
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Provider Business Mailing Address
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Address Line | PO BOX 650187
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City | VERO BEACH
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State | FL
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Zip | 32965-0187
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Country | US
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Telephone | 954-647-7808
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Fax | 772-205-2326
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Authorized Official
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Title or Position | OWNER
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Name | BEVERLEY WEST
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Credential | NURSE
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Telephone | 954-647-7807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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