1760296586 NPI number — IGNITE HOME HEALTH -REGION 6 LLC

Table of content: STEPHEN JOHN SIMONETTI D.D.S. (NPI 1477172872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760296586 NPI number — IGNITE HOME HEALTH -REGION 6 LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IGNITE HOME HEALTH -REGION 6 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:
1760296586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4030 HENDERSON BLVD STE 541
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33629-4940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-409-5550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4830 W KENNEDY BLVD STE 880
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-298-5479
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2025

Additional Information

Authorized Official

Authorized Official Last Name:
HAUSMAN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
727-409-5550

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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