1477621589 NPI number — NURSING HOME DIVERSION AMERICAN ELDERCARE INC

Table of content: (NPI 1477621589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477621589 NPI number — NURSING HOME DIVERSION AMERICAN ELDERCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NURSING HOME DIVERSION AMERICAN ELDERCARE 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:
Provider Other Organization Name Type Code:
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:
1477621589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14565 SIMS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33484-8549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-496-4440
Provider Business Mailing Address Fax Number:
561-860-8607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14565 SIMS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33484-8547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-499-9656
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHEMEL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-499-9656

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302R00000X , with the licence number: 299991930 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302R00000X , with the licence number: 299991915 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 302R00000X , with the licence number: 299991713 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 015031220 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031227 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031234 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031237 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031223 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031231 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031233 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031221 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031222 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031228 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031230 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031235 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031232 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031229 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031224 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031226 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031236 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015031225 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com