1831246255 NPI number — BOCA RATON REGIONAL HOSPITAL, INC.

Table of content: (NPI 1831246255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831246255 NPI number — BOCA RATON REGIONAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOCA RATON REGIONAL HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRRH HOME HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831246255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 GLADES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-6414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-955-4040
Provider Business Mailing Address Fax Number:
561-955-2165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 GLADES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-6414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-955-4040
Provider Business Practice Location Address Fax Number:
561-955-2165
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FEDELE
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
561-955-5484

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299993003 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)