MEDICARE: CAREPLEX REGISTRY LLC

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

General Provider Information

NPI Number	:	1588082044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREPLEX REGISTRY LLC

Provider Business Mailing Address
First Line	:	150 NW 70TH AVE
Second Line	:	STE 9
City	:	PLANTATION
State	:	FL
Zip	:	33317-2911
Country	:	US
Telephone Number	:	954-801-6819
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 NW 70TH AVE
Second Line	:	STE 9B
City	:	PLANTATION
State	:	FL
Zip	:	33317-2911
Country	:	US
Telephone Number	:	954-801-6819
Fax Number	:

Authorized Official
Title or Position	:	A
Name	:	LAVONE JACKSON
Credential	:
Telephone Number	:	954-801-6819

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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Directions to “CAREPLEX REGISTRY LLC ” Practice Location

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