1386934024 NPI number — OAKLEAF HOME HEALTH AGENCY, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386934024 NPI number — OAKLEAF HOME HEALTH AGENCY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKLEAF HOME HEALTH AGENCY, INC
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:
Provider Other Organization Name Type Code:
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:
1386934024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3590 S STATE ROAD 7
Provider Second Line Business Mailing Address:
SUITE 33
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33023-5284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-237-4773
Provider Business Mailing Address Fax Number:
877-802-0651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3590 S STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE 33
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33023-5284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-237-4773
Provider Business Practice Location Address Fax Number:
877-802-0651
Provider Enumeration Date:
04/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
LA-VERNE
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
954-237-4773

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)





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