Provider Demographics
NPI:1104579499
Name:200 TEAM LLC
Entity type:Organization
Organization Name:200 TEAM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILOCTETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-488-6576
Mailing Address - Street 1:1700 N DIXIE HWY STE 129
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1808
Mailing Address - Country:US
Mailing Address - Phone:561-409-3387
Mailing Address - Fax:
Practice Address - Street 1:1700 N DIXIE HWY STE 129
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1808
Practice Address - Country:US
Practice Address - Phone:561-409-3387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113278900Medicaid