Provider Demographics
NPI:1558663161
Name:FAMILY CARE NURSES REG LLC
Entity Type:Organization
Organization Name:FAMILY CARE NURSES REG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:IULDA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-686-4552
Mailing Address - Street 1:4047 OKEECHOBEE BLVD
Mailing Address - Street 2:#124
Mailing Address - City:WEST PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33409
Mailing Address - Country:US
Mailing Address - Phone:561-686-4552
Mailing Address - Fax:561-686-4528
Practice Address - Street 1:4047 OKEECHOBEE BLVD
Practice Address - Street 2:#124
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-686-4552
Practice Address - Fax:561-686-4528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211111376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683964996Medicaid