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General NPI Number Information
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NPI Number | 1245899020
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Entity Type | Organization
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Legal Business Name | MHC AREA 9, LLC
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 6001 BROKEN SOUND PKWY NW STE 220
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City | BOCA RATON
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State | FL
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Zip | 33487-2754
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Country | US
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Telephone | 561-327-9060
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Fax |
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Provider Business Mailing Address
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Address Line | 885 PENNIMAN AVE UNIT 6426
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City | PLYMOUTH
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State | MI
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Zip | 48170-7722
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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 | DIRECTOR OF CLINICAL SERVICES
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Name | KRISTI JACKSON
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Credential |
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Telephone | 941-257-4285
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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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