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General NPI Number Information
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NPI Number | 1306627344
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Entity Type | Organization
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Legal Business Name | ADDI VILLAGE INC
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 309 SW 68TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33023-1134
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Country | US
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Telephone | 954-854-7389
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Fax |
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Provider Business Mailing Address
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Address Line | 309 SW 68TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33023-1134
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Country | US
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Telephone | 954-854-7389
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BETSY JOSEPH
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Credential | REGISTERED NURSE
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Telephone | 954-854-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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