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General NPI Number Information
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NPI Number | 1851044168
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Entity Type | Organization
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Legal Business Name | SUPERHERO KIDS PPEC, LLC.
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 1700 W WOOLBRIGHT RD STE 3
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6346
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Country | US
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Telephone | 561-877-2152
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Fax | 561-810-4197
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Provider Business Mailing Address
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Address Line | 1700 W WOOLBRIGHT RD STE 3
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6346
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Country | US
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Telephone | 561-877-2152
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Fax | 561-810-4197
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | KELSEY ALLEN
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Credential |
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Telephone | 561-877-2152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State |
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