Provider Demographics
NPI:1255729026
Name:PLAY SAFE LLC
Entity type:Organization
Organization Name:PLAY SAFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHONA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-456-5680
Mailing Address - Street 1:1008 WEST HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:954-456-5680
Mailing Address - Fax:954-456-5682
Practice Address - Street 1:1008 WEST HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-456-5680
Practice Address - Fax:954-456-5682
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLAY SAFE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-02
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNPN9192902261QM1300X
FLARNP9192984261QM1300X
FLME47182261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010284000Medicaid
FL000274400Medicaid
FL000274400Medicaid
FLHH7872Medicare PIN
FLHH7872Medicare UPIN