1215570338 NPI number — MOXMAN HOME CARE LLC

Table of content: MS. DENISE ANASTASIA DELPH LCSW (NPI 1720325582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215570338 NPI number — MOXMAN HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOXMAN HOME 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:
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:
1215570338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 COVINGTON CV SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33880-4555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-875-4376
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 4TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33880-2910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-877-3992
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MOXAM
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
863-289-0117

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: 299994949 . This is a "HOME HEALTH AGENCY (ISSUED BY AHCA)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com