Provider Demographics
NPI:1841284726
Name:ACK-TEN GROUP LLC
Entity type:Organization
Organization Name:ACK-TEN GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-739-9674
Mailing Address - Street 1:2404 B SOUTH SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6704
Mailing Address - Country:US
Mailing Address - Phone:561-739-9674
Mailing Address - Fax:561-739-9688
Practice Address - Street 1:2404 B SOUTH SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6704
Practice Address - Country:US
Practice Address - Phone:561-739-9674
Practice Address - Fax:561-739-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 4504261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
200338OtherHEALTHEASE
FLV2514OtherBLUE CROSS BLUE SHIELD
FLP00078188Medicare PIN
FLE7580AMedicare PIN