Provider Demographics
NPI:1871071944
Name:MERRICK NURSE REGISTRY LLC
Entity type:Organization
Organization Name:MERRICK NURSE REGISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-713-1123
Mailing Address - Street 1:840 SW 81ST AVE
Mailing Address - Street 2:SUITE 302 M
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068
Mailing Address - Country:US
Mailing Address - Phone:561-713-1123
Mailing Address - Fax:561-713-1124
Practice Address - Street 1:8461 LAKE WORTH RD STE 1-133
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2474
Practice Address - Country:US
Practice Address - Phone:561-713-1123
Practice Address - Fax:561-713-1124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERRICK NURSE REGISTRY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-01
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211985251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102407600Medicaid
FL018729000Medicaid