Provider Demographics
NPI:1679802722
Name:COMMUNITY ACCESS SERVICE
Entity Type:Organization
Organization Name:COMMUNITY ACCESS SERVICE
Other - Org Name:MARRYSHOW HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NEA
Authorized Official - Middle Name:DUNCAN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-234-2364
Mailing Address - Street 1:3810 INVERRARY BLVD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4356
Mailing Address - Country:US
Mailing Address - Phone:954-234-2364
Mailing Address - Fax:954-234-2595
Practice Address - Street 1:2141 NW 63RD AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2915
Practice Address - Country:US
Practice Address - Phone:954-234-2364
Practice Address - Fax:954-234-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12115310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006136900Medicaid
FL111190100Medicaid