Provider Demographics
NPI:1083375794
Name:DUCOR HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:DUCOR HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSAQUOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-269-0938
Mailing Address - Street 1:302 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:267-269-0938
Mailing Address - Fax:
Practice Address - Street 1:302 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:267-269-0938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care