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General NPI Number Information
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NPI Number | 1427311182
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Entity Type | Organization
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Legal Business Name | JR YOUNG BUILDERS INC
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 301 NE 51ST ST SUITE 1240
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City | BOCA RATON
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State | FL
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Zip | 33431-4917
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Country | US
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Telephone | 561-953-1147
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Fax |
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Provider Business Mailing Address
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Address Line | 301 NE 51ST ST SUITE 1240
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City | BOCA RATON
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State | FL
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Zip | 33431-4917
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Country | US
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Telephone | 561-953-1147
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSE RAHAMAN
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Credential |
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Telephone | 954-294-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | CGC1517172
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License Number State | FL
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