1801069174 NPI number — JEWISH RESIDENTIAL & FAMILY SERVICES

Table of content: (NPI 1801069174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801069174 NPI number — JEWISH RESIDENTIAL & FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH RESIDENTIAL & FAMILY SERVICES
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:
1801069174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5841 CORPORATE WAY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33407-2039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-684-1991
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
198 SPARROW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411-1697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-684-1991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NEWSTEIN
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
561-684-1991

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  090920 , 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)

  • Identifier: 677114996 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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