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General NPI Number Information
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NPI Number | 1932336187
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE OF BROWARD COUNTY, INC.
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 650 N ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-7436
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Country | US
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Telephone | 954-463-4217
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Fax | 954-764-3825
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Provider Business Mailing Address
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Address Line | 650 N ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-7436
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Country | US
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Telephone | 954-463-4217
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Fax | 954-764-3825
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ELLY DU PRE
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Credential | DPA
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Telephone | 954-463-4217
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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 | FL
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