Provider Demographics
NPI:1225465594
Name:SENIORBRIDGE-FLORIDA LLC
Entity Type:Organization
Organization Name:SENIORBRIDGE-FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:RACKOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-994-6108
Mailing Address - Street 1:845 3RD AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6629
Mailing Address - Country:US
Mailing Address - Phone:212-994-6100
Mailing Address - Fax:212-994-4260
Practice Address - Street 1:8751 W BROWARD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2630
Practice Address - Country:US
Practice Address - Phone:954-423-2217
Practice Address - Fax:954-475-8071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIORBRIDGE FAMILY COMPANIES (FL), INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21033096251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care