Provider Demographics
NPI:1609338698
Name:DEFINITIVE CAREGIVERS
Entity Type:Organization
Organization Name:DEFINITIVE CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-270-4900
Mailing Address - Street 1:1900 GLADES RD STE 500-63
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7378
Mailing Address - Country:US
Mailing Address - Phone:561-270-4900
Mailing Address - Fax:561-931-6522
Practice Address - Street 1:100 E LINTON BLVD STE 136A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3330
Practice Address - Country:US
Practice Address - Phone:561-270-4900
Practice Address - Fax:561-931-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105829700Medicaid