Provider Demographics
NPI:1770716037
Name:DERASH INC
Entity type:Organization
Organization Name:DERASH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUAZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-334-0305
Mailing Address - Street 1:1459 LAKE BALDWIN LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6741
Mailing Address - Country:US
Mailing Address - Phone:407-893-3905
Mailing Address - Fax:407-893-3906
Practice Address - Street 1:13453 N MAIN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2710
Practice Address - Country:US
Practice Address - Phone:904-757-4688
Practice Address - Fax:904-757-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health