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General NPI Number Information
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NPI Number | 1447740840
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Entity Type | Individual
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Provider Name | WILZADE JOSEPH
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Gender | Male
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 22319 SW 65TH AVE
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City | BOCA RATON
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State | FL
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Zip | 33428
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Country | US
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Telephone | 954-793-6290
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Fax |
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Provider Business Mailing Address
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Address Line | 22319 SW 65TH AVE
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City | BOCA RATON
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State | FL
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Zip | 33428-6010
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Country | US
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Telephone | 954-793-6290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 171239824
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 171239824
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 171239824
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | 171239824
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 171239824
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License Number State | FL
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