MEDICARE: ATENDA NURSING CARE

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	310400000X	Assisted Living Facility	15426398	FL
2	311Z00000X	Custodial Care Facility	311Z00000X	FL
3	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1750618690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATENDA NURSING CARE

Provider Business Mailing Address
First Line	:	2510 SCOTT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-2357
Country	:	US
Telephone Number	:	305-305-3857
Fax Number	:	954-923-3205

Provider Business Practice Location Address
First Line	:	2510 SCOTT STREET
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020
Country	:	US
Telephone Number	:	305-305-3857
Fax Number	:	954-923-3205

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	SHERLY BOURSIQUOT
Credential	:	BSW
Telephone Number	:	305-305-3857

Provider Enumeration Date	:	11/13/2009
Last Update Date	:	11/13/2009

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