MEDICARE: POINCIANA HEALTH CORP.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1962428755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POINCIANA HEALTH CORP.

Provider Business Mailing Address
First Line	:	5804 STIRLING RD
Second Line	:	SPACE 3
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1527
Country	:	US
Telephone Number	:	954-989-2629
Fax Number	:	305-989-2629

Provider Business Practice Location Address
First Line	:	5804 STIRLING RD
Second Line	:	SPACE 3
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1527
Country	:	US
Telephone Number	:	954-989-2629
Fax Number	:	305-989-2629

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LISSETTE ALVAREZ
Credential	:
Telephone Number	:	954-989-2628

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	08/22/2020

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Directions to “POINCIANA HEALTH CORP. ” Practice Location

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