1366106734 NPI number — GLOBEX COMMUNITY DEVELOPMENT CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366106734 NPI number — GLOBEX COMMUNITY DEVELOPMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLOBEX COMMUNITY DEVELOPMENT CENTER
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:
1366106734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10362 BUENA VENTURA DR
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:
33498-6710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-270-9321
Provider Business Mailing Address Fax Number:
561-649-0238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 N FEDERAL HWY STE 205
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:
33487-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-270-9321
Provider Business Practice Location Address Fax Number:
561-649-0238
Provider Enumeration Date:
10/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BLAND
Authorized Official First Name:
ELISA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINTRATOR
Authorized Official Telephone Number:
561-313-7113

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001246501 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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