Provider Demographics
NPI:1033976964
Name:BEDROCK AT HOME ORLANDO, LLC
Entity Type:Organization
Organization Name:BEDROCK AT HOME ORLANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-505-4602
Mailing Address - Street 1:3800 TOWN CTR BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6196
Mailing Address - Country:US
Mailing Address - Phone:407-505-4602
Mailing Address - Fax:407-505-4603
Practice Address - Street 1:3800 TOWN CTR BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6196
Practice Address - Country:US
Practice Address - Phone:407-505-4602
Practice Address - Fax:407-505-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care