Provider Demographics
NPI:1205359320
Name:COMMUNITY DEVELOPMENT AND EMPOWERMENT GROUP, INC.
Entity Type:Organization
Organization Name:COMMUNITY DEVELOPMENT AND EMPOWERMENT GROUP, INC.
Other - Org Name:FORWARD INNOVATIVE HOME HEALTH CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CHIEF NURSING EXECUTIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:MERRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, PHD CANDIDA
Authorized Official - Phone:561-685-1154
Mailing Address - Street 1:P.O. BOX 210041
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421
Mailing Address - Country:US
Mailing Address - Phone:561-685-1154
Mailing Address - Fax:561-567-0928
Practice Address - Street 1:3148 LAUREL RIDGE CIRCLE
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404
Practice Address - Country:US
Practice Address - Phone:561-567-0918
Practice Address - Fax:561-567-0928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY DEVELOPMENT AND EMPOWERMENT GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9242701163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty