MEDICARE: FOUR CORNERS NURSING SERVICES 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	253Z00000X	In Home Supportive Care Agency
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1962337816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR CORNERS NURSING SERVICES LLC

Provider Business Mailing Address
First Line	:	621 NW 53RD ST # 22
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-8235
Country	:	US
Telephone Number	:	561-823-6940
Fax Number	:	954-333-6198

Provider Business Practice Location Address
First Line	:	621 NW 53RD ST # 22
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-8235
Country	:	US
Telephone Number	:	561-823-6940
Fax Number	:	954-333-6198

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS NICOLA WEBB
Credential	:
Telephone Number	:	954-661-9741

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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