MEDICARE: BOPPAS HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care	12106	FL

General Provider Information

NPI Number	:	1053778480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOPPAS HOME

Provider Business Mailing Address
First Line	:	440 CATALINA AVE NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-1835
Country	:	US
Telephone Number	:	321-327-5350
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 CATALINA AVE NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-1835
Country	:	US
Telephone Number	:	321-327-5350
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BETHANN MEYER
Credential	:	RN
Telephone Number	:	321-327-5350

Provider Enumeration Date	:	01/15/2016
Last Update Date	:	01/15/2016

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Directions to “BOPPAS HOME ” Practice Location

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