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General NPI Number Information
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NPI Number | 1194132894
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Entity Type | Organization
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Legal Business Name | BLC THERAPEUTIC RESOURCES
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 12741 SW 17TH CT
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City | MIRAMAR
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State | FL
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Zip | 33027-2500
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Country | US
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Telephone | 786-663-0707
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Fax | 954-447-8844
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Provider Business Mailing Address
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Address Line | 12741 SW 17TH CT
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City | MIRAMAR
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State | FL
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Zip | 33027-2500
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Country | US
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Telephone | 786-663-0707
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Fax | 954-447-8844
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BELKYS CAMPOS
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Credential | O.T.R
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Telephone | 786-663-0707
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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 | OTA12597
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License Number State | FL
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