Provider Demographics
NPI:1043488869
Name:BOCA RIDGE ENTERPRISES
Entity type:Organization
Organization Name:BOCA RIDGE ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF RPH/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MERVIN
Authorized Official - Last Name:EFRUSY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:586-757-6505
Mailing Address - Street 1:22835 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2356
Mailing Address - Country:US
Mailing Address - Phone:586-757-6505
Mailing Address - Fax:586-757-7785
Practice Address - Street 1:22835 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2356
Practice Address - Country:US
Practice Address - Phone:586-757-6505
Practice Address - Fax:586-757-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies