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General NPI Number Information
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NPI Number | 1225465594
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Entity Type | Organization
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Legal Business Name | SENIORBRIDGE-FLORIDA LLC
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 8751 W BROWARD BLVD STE 200
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City | PLANTATION
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State | FL
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Zip | 33324-2630
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Country | US
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Telephone | 954-423-2217
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Fax | 954-475-8071
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Provider Business Mailing Address
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Address Line | 845 3RD AVE FL 7
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City | NEW YORK
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State | NY
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Zip | 10022-6629
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Country | US
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Telephone | 212-994-6100
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Fax | 212-994-4260
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. ERIC C RACKOW
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Credential | M.D.
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Telephone | 212-994-6108
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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 | 21033096
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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 | 21033096
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License Number State | FL
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