=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164959581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R&R DOMESTIC SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2017
-----------------------------------------------------
Last Update Date | 05/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6635 W COMMERCIAL BLVD
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33319-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 745-702-5702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2960 RIVERSIDE DR APT 112
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-5522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-268-7704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CLARENCE H. ROBINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 754-702-5702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------