MEDICARE: ELIGIBOLT 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1821699216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIGIBOLT LLC

Provider Business Mailing Address
First Line	:	1457 E BEXLEY PARK DR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3543
Country	:	US
Telephone Number	:	305-434-2072
Fax Number	:

Provider Business Practice Location Address
First Line	:	1457 E BEXLEY PARK DR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3543
Country	:	US
Telephone Number	:	305-434-2072
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. RICHARD GLASER
Credential	:
Telephone Number	:	305-434-2072

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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