Provider Demographics
NPI:1700025608
Name:VIRGIN HEALTH OF WEST PALM LLC.
Entity Type:Organization
Organization Name:VIRGIN HEALTH OF WEST PALM LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:V
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:561-277-2121
Mailing Address - Street 1:951 YAMATO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4439
Mailing Address - Country:US
Mailing Address - Phone:561-277-2121
Mailing Address - Fax:561-491-6533
Practice Address - Street 1:951 YAMATO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4439
Practice Address - Country:US
Practice Address - Phone:561-277-2121
Practice Address - Fax:561-491-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993250251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health