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General NPI Number Information
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NPI Number | 1114814282
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Entity Type | Organization
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Legal Business Name | KINSHIP PACE OF SOUTH FLORIDA
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Dates
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Enumeration Date | 06/21/2025
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Last Update Date | 06/21/2025
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Provider Practice Location Address
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Address Line | 2555 DAVIE RD
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City | DAVIE
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State | FL
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Zip | 33317-7424
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Country | US
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Telephone | 866-211-7082
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Fax |
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Provider Business Mailing Address
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Address Line | 885 3RD AVE FL 29
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City | NEW YORK
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State | NY
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Zip | 10022-4834
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Country | US
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Telephone | 727-417-5819
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | LISA GARAY
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Credential |
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Telephone | 201-675-5663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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