MEDICARE: RONI KOMIE

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	314000000X	Skilled Nursing Facility	SW2806	FL

General Provider Information

NPI Number	:	1508115957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONI KOMIE

Provider Business Mailing Address
First Line	:	2751 S OCEAN DR
Second Line	:	1803-S
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-2721
Country	:	US
Telephone Number	:	954-929-5797
Fax Number	:	954-929-5798

Provider Business Practice Location Address
First Line	:	2751 S OCEAN DR
Second Line	:	1803-S
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-2721
Country	:	US
Telephone Number	:	954-929-5797
Fax Number	:	954-929-5798

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MS. RONI S KOMIE
Credential	:	LCSW
Telephone Number	:	954-929-5797

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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Directions to “RONI KOMIE ” Practice Location

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