Provider Demographics
NPI:1447372099
Name:BOCA GROUP LLC
Entity type:Organization
Organization Name:BOCA GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPIERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-483-0498
Mailing Address - Street 1:9945 CENTRAL PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1745
Mailing Address - Country:US
Mailing Address - Phone:561-483-0498
Mailing Address - Fax:561-483-2982
Practice Address - Street 1:9945 CENTRAL PARK BLVD N
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1745
Practice Address - Country:US
Practice Address - Phone:561-483-0498
Practice Address - Fax:561-483-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF 1343096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0-229-628-00Medicaid
FL0-229-628-00Medicaid