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General NPI Number Information
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NPI Number | 1336377704
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Entity Type | Organization
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Legal Business Name | PAA OF BROWARD
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 1100 NE 45TH ST SUITE 142
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City | OAKLAND PARK
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State | FL
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Zip | 33334-3814
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Country | US
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Telephone | 954-661-1911
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 NE 45TH ST SUITE 142
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City | OAKLAND PARK
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State | FL
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Zip | 33334-3814
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Country | US
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Telephone | 954-661-1911
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAVID WENNIGER
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Credential |
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Telephone | 954-661-1911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 2849452
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License Number State | FL
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