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General NPI Number Information
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NPI Number | 1043922669
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Entity Type | Organization
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Legal Business Name | HEARTLAND BOYNTON OPCO LLC
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 3600 OLD BOYNTON RD
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-3912
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Country | US
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Telephone | 561-736-9992
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PROVIDER CT
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City | RICHMOND
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State | KY
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Zip | 40475-8488
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Country | US
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Telephone | 917-817-3530
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED PERSON
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Name | MATHEW VARGHESE
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Credential |
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Telephone | 917-817-3530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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