Provider Demographics
NPI:1386691749
Name:PALM COURT NH, LLC
Entity type:Organization
Organization Name:PALM COURT NH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-635-9500
Mailing Address - Street 1:2675 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2509
Mailing Address - Country:US
Mailing Address - Phone:954-563-5711
Mailing Address - Fax:954-563-5729
Practice Address - Street 1:2675 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-2509
Practice Address - Country:US
Practice Address - Phone:954-563-5711
Practice Address - Fax:954-563-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF14050963332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5551000001Medicare NSC