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General NPI Number Information
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NPI Number | 1184131435
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Entity Type | Organization
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Legal Business Name | 01030712 LLC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 3801 PGA BLVD SUITE 600 - OFFICE 651
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410
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Country | US
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Telephone | 561-293-2522
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Fax | 561-284-8811
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Provider Business Mailing Address
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Address Line | 153 BENT TREE DR
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-3599
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN NEAL
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Credential |
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Telephone | 561-290-0980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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