MEDICARE: BLACK FAMILY HERITAGE ESTATES MINISTRY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163W00000X	Registered Nurse
2	208D00000X	General Practice Physician
3	251J00000X	Nursing Care Agency
4	251S00000X	Community/Behavioral Health Agency
5	311500000X	Alzheimer Center (Dementia Center)
6	3140N1450X	Pediatric Skilled Nursing Facility
7	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
8	324500000X	Substance Abuse Rehabilitation Facility
9	385HR2055X	Child Mental Illness Respite Care
10	385HR2065X	Child Physical Disabilities Respite Care
11	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1306227293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK FAMILY HERITAGE ESTATES MINISTRY

Provider Business Mailing Address
First Line	:	3465 NW 43RD PL
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4240
Country	:	US
Telephone Number	:	954-625-4772
Fax Number	:

Provider Business Practice Location Address
First Line	:	3465 NW 43RD PL
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4240
Country	:	US
Telephone Number	:	954-625-4772
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MARSHA THOMPSON
Credential	:
Telephone Number	:	954-625-4772

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	06/16/2015

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