Provider Demographics
NPI:1821540535
Name:SURCAN HOLDINGS LLC
Entity Type:Organization
Organization Name:SURCAN HOLDINGS LLC
Other - Org Name:MINK CONCIERGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNROD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-247-9069
Mailing Address - Street 1:217 N SEACREST BLVD
Mailing Address - Street 2:SUITE #712
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33425-6901
Mailing Address - Country:US
Mailing Address - Phone:561-247-9069
Mailing Address - Fax:
Practice Address - Street 1:217 N SEACREST BLVD
Practice Address - Street 2:SUITE #712
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33425-6901
Practice Address - Country:US
Practice Address - Phone:461-247-9069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233329253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010134400Medicaid