Provider Demographics
NPI:1245653450
Name:AQUANOVA INC
Entity type:Organization
Organization Name:AQUANOVA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEAUBOEUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-209-6550
Mailing Address - Street 1:18004 NW 6TH ST
Mailing Address - Street 2:104
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2823
Mailing Address - Country:US
Mailing Address - Phone:800-209-6550
Mailing Address - Fax:954-885-1340
Practice Address - Street 1:18004 NW 6TH ST
Practice Address - Street 2:104
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2823
Practice Address - Country:US
Practice Address - Phone:800-209-6550
Practice Address - Fax:954-885-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682601Medicare Oscar/Certification