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General NPI Number Information
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NPI Number | 1679399810
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Entity Type | Organization
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Legal Business Name | SUCCESSFUL AGING CARE NET OF FLORIDA INC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 2054 VISTA PKWY STE 449
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-6741
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Country | US
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Telephone | 561-709-3466
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Fax |
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Provider Business Mailing Address
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Address Line | 38 GARRETT RD
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City | UPPER DARBY
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State | PA
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Zip | 19082-2303
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Country | US
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Telephone | 561-709-3466
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JIMMENELL HAIRSTON
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Credential |
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Telephone | 856-264-6008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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