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General NPI Number Information
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NPI Number | 1134670516
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Entity Type | Organization
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Legal Business Name | VIRGO HEALTH CARE
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 1774 15TH AVE N
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City | LAKE WORTH
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State | FL
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Zip | 33460-1734
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Country | US
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Telephone | 321-362-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 1774 15TH AVE N
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City | LAKE WORTH
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State | FL
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Zip | 33460-1734
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Country | US
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Telephone | 321-362-6622
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Fax |
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Authorized Official
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Title or Position | SIR
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Name | PROSPER JOSEPH
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Credential |
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Telephone | 321-362-6622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | FL
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