Provider Demographics
NPI:1558534628
Name:MARY SEACOLE HEALTHCARE
Entity Type:Organization
Organization Name:MARY SEACOLE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-964-7674
Mailing Address - Street 1:4321 ROCK ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4527
Mailing Address - Country:US
Mailing Address - Phone:954-964-7674
Mailing Address - Fax:954-636-2079
Practice Address - Street 1:4321 ROCK ISLAND RD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4527
Practice Address - Country:US
Practice Address - Phone:954-964-7674
Practice Address - Fax:954-636-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230207251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health