=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598048241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIORBRIDGE FAMILY COMPANIES (FL), INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2011
-----------------------------------------------------
Last Update Date | 10/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2424 N FEDERAL HWY SUITE 251
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-7735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-338-9399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 845 3RD AVE 7TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-6601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-994-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR ACCREDITATION PROFESSIONAL
-----------------------------------------------------
Name | MELISSA STROCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-301-2178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 299991549
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------