MEDICARE: NURSE CARE REGISTRY

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	251E00000X	Home Health Agency	IN PROCESS	FL

General Provider Information

NPI Number	:	1386188209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSE CARE REGISTRY

Provider Business Mailing Address
First Line	:	837 NE 20TH AVE
Second Line	:	SUITE 102
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3035
Country	:	US
Telephone Number	:	754-701-5225
Fax Number	:	754-701-5231

Provider Business Practice Location Address
First Line	:	837 NE 20TH AVE
Second Line	:	SUITE 102
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3035
Country	:	US
Telephone Number	:	754-701-5225
Fax Number	:	754-701-5231

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRADLEY THOMAS DANYLUK
Credential	:
Telephone Number	:	754-701-5225

Provider Enumeration Date	:	12/12/2016
Last Update Date	:	12/12/2016

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