Provider Demographics
NPI:1780210609
Name:BOYNTON BEACH HEALTHCARE SERVICES, LLC.
Entity type:Organization
Organization Name:BOYNTON BEACH HEALTHCARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-317-8902
Mailing Address - Street 1:3005 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-9045
Mailing Address - Country:US
Mailing Address - Phone:561-317-8902
Mailing Address - Fax:
Practice Address - Street 1:3005 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-9045
Practice Address - Country:US
Practice Address - Phone:561-317-8902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility