Provider Demographics
NPI:1366106734
Name:GLOBEX COMMUNITY DEVELOPMENT CENTER
Entity type:Organization
Organization Name:GLOBEX COMMUNITY DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-313-7113
Mailing Address - Street 1:10362 BUENA VENTURA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6710
Mailing Address - Country:US
Mailing Address - Phone:561-270-9321
Mailing Address - Fax:561-649-0238
Practice Address - Street 1:5301 N FEDERAL HWY STE 205
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4915
Practice Address - Country:US
Practice Address - Phone:561-270-9321
Practice Address - Fax:561-649-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001246501Medicaid