MEDICARE: M NICOLAS ENTERPRISE 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	251C00000X	Developmentally Disabled Services Day Training Agency
2	261Q00000X	Clinic/Center
3	261QD1600X	Developmental Disabilities Clinic/Center
4	385H00000X	Respite Care
5	261QA0600X	Adult Day Care Clinic/Center	9397	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962883728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M NICOLAS ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	2500 METROCENTRE BLVD STE 8
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3107
Country	:	US
Telephone Number	:	800-409-3804
Fax Number	:	800-268-2183

Provider Business Practice Location Address
First Line	:	2500 METROCENTRE BLVD STE 7-8
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3107
Country	:	US
Telephone Number	:	800-409-3804
Fax Number	:	800-268-2183

Authorized Official
Title or Position	:	PRESIDENT WORLD WIDE HEALTH SERVICE
Name	:	MS. MICHELLE NICOLAS
Credential	:
Telephone Number	:	800-268-2183

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	11/01/2022

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Directions to “M NICOLAS ENTERPRISE LLC ” Practice Location

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