=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336313337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAMPER YOUR PARENTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2008
-----------------------------------------------------
Last Update Date | 04/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14527 BONAIRE BLVD #307
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-638-1308
-----------------------------------------------------
Fax | 561-637-0257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14527 BONAIRE BLVD #307
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-638-1308
-----------------------------------------------------
Fax | 561-637-0257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | MS. CHARLOTTE M MCCOB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-313-2608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------