Provider Demographics
NPI:1700872793
Name:ADVENTURA SICKROOM SUPPLY, INC.
Entity Type:Organization
Organization Name:ADVENTURA SICKROOM SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-458-1959
Mailing Address - Street 1:136 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5507
Mailing Address - Country:US
Mailing Address - Phone:954-458-1959
Mailing Address - Fax:954-458-1885
Practice Address - Street 1:136 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5507
Practice Address - Country:US
Practice Address - Phone:954-458-1959
Practice Address - Fax:954-458-1885
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
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL174OtherAHCA
FL0330720001Medicare NSC