1124764428 NPI number — T.L.C. NURSING REGISTRY

Table of content: (NPI 1124764428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124764428 NPI number — T.L.C. NURSING REGISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T.L.C. NURSING REGISTRY
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:
1124764428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2514 HOLLYWOOD BLVD STE 508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33020-6635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-964-5500
Provider Business Mailing Address Fax Number:
954-964-5511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9990 COCONUT ROAD
Provider Second Line Business Practice Location Address:
SUITE 318
Provider Business Practice Location Address City Name:
BONITA SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-964-5500
Provider Business Practice Location Address Fax Number:
954-964-5511
Provider Enumeration Date:
05/09/2022

Additional Information

Authorized Official

Authorized Official Last Name:
SAHARI
Authorized Official First Name:
FARID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-964-5500

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 024540600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117430800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com