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General NPI Number Information
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NPI Number | 1588012744
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Entity Type | Organization
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Legal Business Name | WGR HOLDINGS MELBOURNE, LLC
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Dates
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Enumeration Date | 05/28/2016
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Last Update Date | 05/28/2016
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Provider Practice Location Address
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Address Line | 760 NORTH DR STE C
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City | MELBOURNE
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State | FL
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Zip | 32934-9216
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Country | US
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Telephone | 321-241-4433
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Fax | 321-241-4437
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Provider Business Mailing Address
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Address Line | 1900 NW CORPORATE BLVD STE 100W
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City | BOCA RATON
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State | FL
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Zip | 33431-8502
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Country | US
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Telephone | 321-241-4433
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Fax | 321-241-4437
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Authorized Official
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Title or Position | CEO
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Name | MR. WILFREDO E MARTINEZ
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Credential |
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Telephone | 321-241-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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