Provider Demographics
NPI:1073892782
Name:DESOTO HOME HEALTH CARE INC.
Entity Type:Organization
Organization Name:DESOTO HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-382-2606
Mailing Address - Street 1:3975 US 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5512
Mailing Address - Country:US
Mailing Address - Phone:863-382-2606
Mailing Address - Fax:863-382-3969
Practice Address - Street 1:3975 US 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5512
Practice Address - Country:US
Practice Address - Phone:863-382-2606
Practice Address - Fax:863-382-3969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESOTO HOME HEALTH CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-11
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313719332B00000X
FL32-6855332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0408570003Medicare NSC