1649598327 NPI number — ORTHO HOME HEALTH CARE, LLC

Table of content: (NPI 1649598327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649598327 NPI number — ORTHO HOME HEALTH CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHO HOME HEALTH CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
A CARE CONNECTION HOME HEALTH, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649598327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 JACKSONVILLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32250-3812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-899-5520
Provider Business Mailing Address Fax Number:
904-899-5521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 JACKSONVILLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32250-3812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-899-5520
Provider Business Practice Location Address Fax Number:
904-899-5521
Provider Enumeration Date:
05/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
DAVIS
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
904-899-5520

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CCN: 10-9709 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com