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General NPI Number Information
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NPI Number | 1245652247
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Entity Type | Organization
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Legal Business Name | N/A
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 2261 S SHERMAN CIR APT. A204
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City | MIRAMAR
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State | FL
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Zip | 33025-2294
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Country | US
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Telephone | 954-243-0626
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Fax |
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Provider Business Mailing Address
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Address Line | 2261 S SHERMAN CIR APT. A204
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City | MIRAMAR
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State | FL
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Zip | 33025-2294
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Country | US
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Telephone | 954-243-0626
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Fax |
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Authorized Official
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Title or Position | REGISTERED RESPIRATORY THERAPIST
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Name | MISS MARJORIE CHAMPAGNE
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Credential |
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Telephone | 954-243-0626
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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 | RT11166
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License Number State | FL
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