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Kim Chancellor

Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Loxahatchee, FL

NPI 1134603152 · NPPES record last updated Sep 17, 2018

Key facts

NPI
1134603152
Entity type
Individual (NPI type 1)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Practice address
13052 Compton Rd
Loxahatchee, FL 33470-4714
Phone
(561) 797-7202
Fax
(561) 795-3014
NPI assigned
Sep 17, 2018
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
C.W.W. Limited LTD Current Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Yes

Addresses

Primary practice location

13052 Compton Rd
Loxahatchee, FL 33470-4714

Mailing address

13052 Compton Rd
Loxahatchee, FL 33470-4714
Phone (561) 797-7202

Other providers in Loxahatchee, FL

All providers in Loxahatchee, FL · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

Sources for this page

Verify at the official NPI Registry.