Provider Demographics
NPI:1134126071
Name:HOSPICE BY THE SEA INC
Entity Type:Organization
Organization Name:HOSPICE BY THE SEA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPRUIT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:561-416-5014
Mailing Address - Street 1:1531 W PALMETTO PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3307
Mailing Address - Country:US
Mailing Address - Phone:561-395-5031
Mailing Address - Fax:561-373-7137
Practice Address - Street 1:1531 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3307
Practice Address - Country:US
Practice Address - Phone:561-395-5031
Practice Address - Fax:561-373-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5011096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087529500Medicaid
FL087529500Medicaid