Provider Demographics
NPI:1972599017
Name:MEDERI OF CORAL SPRINGS, INC
Entity Type:Organization
Organization Name:MEDERI OF CORAL SPRINGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:NESSLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-668-9020
Mailing Address - Street 1:PO BOX 144536
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-4536
Mailing Address - Country:US
Mailing Address - Phone:305-668-9020
Mailing Address - Fax:305-661-4910
Practice Address - Street 1:10011 PINES BLVD
Practice Address - Street 2:SUITE 203D
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6189
Practice Address - Country:US
Practice Address - Phone:305-668-9020
Practice Address - Fax:305-661-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-8145Medicare ID - Type UnspecifiedHOME HEALTH CARE