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General NPI Number Information
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NPI Number | 1962998021
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA HOME MODIFICATION LLC
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 931 VILLAGE BLVD STE 905-417
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-1803
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Country | US
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Telephone | 561-660-4480
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Fax |
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Provider Business Mailing Address
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Address Line | 931 VILLAGE BLVD STE 905-417
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-1803
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Country | US
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Telephone | 561-660-4480
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Fax |
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Authorized Official
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Title or Position | MGR/MEMBER
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Name | JEAN RUSSO
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Credential |
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Telephone | 561-660-4480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State | FL
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