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General NPI Number Information
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NPI Number | 1831185982
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Entity Type | Organization
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Legal Business Name | ACK-TEN GROUP LLC
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 10140 W FOREST HILL BLVD
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City | WELLINGTON
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State | FL
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Zip | 33414-6111
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Country | US
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Telephone | 561-798-7350
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Fax | 561-798-7354
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Provider Business Mailing Address
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Address Line | 2828 S SEACREST BLVD SUITE 202
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7944
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Country | US
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Telephone | 561-739-9674
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Fax | 561-739-9688
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORDAN LITTEN
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Credential |
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Telephone | 561-739-9674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC4567
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License Number State | FL
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