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General NPI Number Information
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NPI Number | 1144573932
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Entity Type | Organization
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Legal Business Name | BH VERO PTL, LLC
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 722 20TH STREET
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City | VERO BEACH
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State | FL
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Zip | 32960
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Country | US
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Telephone | 772-978-7719
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Fax | 772-978-7721
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Provider Business Mailing Address
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Address Line | 1750 W. BROADWAY STREET SUITE 220
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City | OVIEDO
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State | FL
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Zip | 32765
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Country | US
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Telephone | 407-542-7821
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Fax | 407-542-7823
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTHONY LANIER BROOKS
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Credential |
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Telephone | 407-542-7821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | FL
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