1679364996 NPI number — RWW SENIOR LIVING OUTPATIENT REHAB SERVICES, LLC

Table of content: TATIANA DANIELLE BORZOTRA TCADC (NPI 1043087232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679364996 NPI number — RWW SENIOR LIVING OUTPATIENT REHAB SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RWW SENIOR LIVING OUTPATIENT REHAB SERVICES, LLC
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:
1679364996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 N WHITTINGTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-394-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10605 S JOG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33437-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-717-7782
Provider Business Practice Location Address Fax Number:
866-849-2728
Provider Enumeration Date:
05/15/2025

Additional Information

Authorized Official

Authorized Official Last Name:
PEMBERTON
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
502-394-2321

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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