1396861647 NPI number — CARETENDERS OF FT. LAUDERDALE, INC

Table of content: (NPI 1396861647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396861647 NPI number — CARETENDERS OF FT. LAUDERDALE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARETENDERS OF FT. LAUDERDALE, 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:
6
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:
1396861647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9510 ORMSBY STATION RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-4081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-891-1000
Provider Business Mailing Address Fax Number:
502-891-8067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5440 NW 33RD AVE
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-6379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-484-2773
Provider Business Practice Location Address Fax Number:
954-484-2241
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LYLES
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
SR. V.P., ADMINISTRATION
Authorized Official Telephone Number:
502-891-1044

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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