Provider Demographics
NPI:1053856575
Name:3D LIVING & HOME SERVICES, INC.
Entity Type:Organization
Organization Name:3D LIVING & HOME SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-930-4404
Mailing Address - Street 1:7857 W SAMPLE RD
Mailing Address - Street 2:SUITE 159
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4711
Mailing Address - Country:US
Mailing Address - Phone:360-930-4404
Mailing Address - Fax:
Practice Address - Street 1:7857 W SAMPLE RD
Practice Address - Street 2:SUITE 159
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4711
Practice Address - Country:US
Practice Address - Phone:360-930-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL011818900253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011818900Medicaid