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General NPI Number Information
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NPI Number | 1508115957
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Entity Type | Organization
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Legal Business Name | RONI KOMIE
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 2751 S OCEAN DR 1803-S
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City | HOLLYWOOD
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State | FL
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Zip | 33019-2721
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Country | US
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Telephone | 954-929-5797
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Fax | 954-929-5798
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Provider Business Mailing Address
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Address Line | 2751 S OCEAN DR 1803-S
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City | HOLLYWOOD
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State | FL
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Zip | 33019-2721
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Country | US
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Telephone | 954-929-5797
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Fax | 954-929-5798
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. RONI S KOMIE
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Credential | LCSW
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Telephone | 954-929-5797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SW2806
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License Number State | FL
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