Provider Demographics
NPI:1336494889
Name:ST THERESAS NURSING REGISTRY, LLC
Entity Type:Organization
Organization Name:ST THERESAS NURSING REGISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-864-8272
Mailing Address - Street 1:7961 W MCNAB RD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-8428
Mailing Address - Country:US
Mailing Address - Phone:954-960-5634
Mailing Address - Fax:954-532-5278
Practice Address - Street 1:7961 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-8428
Practice Address - Country:US
Practice Address - Phone:954-960-5634
Practice Address - Fax:954-532-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211552251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health