1760593495 NPI number — SOUTHERN HEALTHCARE SERVICES, LLC

Table of content: (NPI 1760593495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760593495 NPI number — SOUTHERN HEALTHCARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN HEALTHCARE 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:
1760593495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASBURY PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07712-2124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-531-6875
Provider Business Mailing Address Fax Number:
732-531-3593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1445 N CONGRESS AVE
Provider Second Line Business Practice Location Address:
SUITE 11 & 12
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33445-6380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-265-4271
Provider Business Practice Location Address Fax Number:
561-423-0819
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOBRICK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, OPERATIONS
Authorized Official Telephone Number:
561-265-4271

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1313044 , 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)





Copyright © 2007-2025 www.npivalidator.com