Provider Demographics
NPI:1841463254
Name:ANTAEUS HEALTH SERVICES OF BROWARD CORP
Entity type:Organization
Organization Name:ANTAEUS HEALTH SERVICES OF BROWARD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-989-1011
Mailing Address - Street 1:3127 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:UNIT 115 B
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5150
Mailing Address - Country:US
Mailing Address - Phone:954-989-1011
Mailing Address - Fax:954-989-9669
Practice Address - Street 1:3127 W HALLANDALE BEACH BLVD
Practice Address - Street 2:UNIT 115 B
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5150
Practice Address - Country:US
Practice Address - Phone:954-989-1011
Practice Address - Fax:954-989-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDING MEDICARE#OtherPENDING MEDICARE#