Provider Demographics
NPI:1003104738
Name:BROWARD LIFECARE, LLC
Entity Type:Organization
Organization Name:BROWARD LIFECARE, LLC
Other - Org Name:BRIGHTSTAR OF FORT LAUDERDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:774-223-3459
Mailing Address - Street 1:4820 SW 161ST LN
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4935
Mailing Address - Country:US
Mailing Address - Phone:774-223-3459
Mailing Address - Fax:774-223-3465
Practice Address - Street 1:777 SE 20TH ST STE 255
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3591
Practice Address - Country:US
Practice Address - Phone:774-223-3459
Practice Address - Fax:774-223-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232250251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health