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General NPI Number Information
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NPI Number | 1578712717
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Entity Type | Organization
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Legal Business Name | INNOVATIVE SENIOR CARE
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 8241 SW 15TH ST 1122
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City | PLANTATION
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State | FL
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Zip | 33324-3271
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Country | US
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Telephone | 954-882-8618
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 W MCNAB RD
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City | POMPANO BEACH
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State | FL
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Zip | 33069-4966
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TEAM LEADER
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Name | APRIL BOTERO
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Credential | PT
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Telephone | 954-970-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | OTA 10427
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OTA 10427
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | OTA 10427
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License Number State | FL
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