Provider Demographics
NPI:1568212082
Name:STANBACK ENTERPRISES LLC
Entity Type:Organization
Organization Name:STANBACK ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-574-2457
Mailing Address - Street 1:4701 N FEDERAL HWY STE 460
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6591
Mailing Address - Country:US
Mailing Address - Phone:954-866-1430
Mailing Address - Fax:
Practice Address - Street 1:4701 N FEDERAL HWY STE 460
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6591
Practice Address - Country:US
Practice Address - Phone:954-866-1430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANBACK ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty