Provider Demographics
NPI:1467691121
Name:EXECUTIVE CARE OF FLORIDA, INC
Entity Type:Organization
Organization Name:EXECUTIVE CARE OF FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VERKHOGLAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-489-4899
Mailing Address - Street 1:270 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5501
Mailing Address - Country:US
Mailing Address - Phone:201-489-4899
Mailing Address - Fax:201-489-5899
Practice Address - Street 1:10227 NW 47 STREET
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-767-4800
Practice Address - Fax:954-767-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health