Provider Demographics
NPI:1083319461
Name:DYNASTY HOME HEALTH LLC
Entity Type:Organization
Organization Name:DYNASTY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-331-5595
Mailing Address - Street 1:6507 ELLIOT DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2603
Mailing Address - Country:US
Mailing Address - Phone:813-447-7220
Mailing Address - Fax:
Practice Address - Street 1:13542 N FLORIDA AVE STE 209C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3759
Practice Address - Country:US
Practice Address - Phone:813-447-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health