Provider Demographics
NPI:1831187350
Name:WHITEHALL BOCA
Entity type:Organization
Organization Name:WHITEHALL BOCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMIN
Authorized Official - Phone:561-392-3000
Mailing Address - Street 1:7300 DEL PRADO CIR S
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3386
Mailing Address - Country:US
Mailing Address - Phone:561-392-3000
Mailing Address - Fax:561-392-4306
Practice Address - Street 1:7300 DEL PRADO CIR S
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3386
Practice Address - Country:US
Practice Address - Phone:561-392-3000
Practice Address - Fax:561-392-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1605095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105506Medicare Oscar/Certification
FL0331560001Medicare NSC