Provider Demographics
NPI:1154855005
Name:HOMEHEALTH
Entity Type:Organization
Organization Name:HOMEHEALTH
Other - Org Name:MARDOCHEDORSONNELLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARDOCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSONNE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:561-870-2798
Mailing Address - Street 1:1717 NW PINE AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475
Mailing Address - Country:US
Mailing Address - Phone:561-870-2798
Mailing Address - Fax:
Practice Address - Street 1:1717 NW PINE AVENUE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475
Practice Address - Country:US
Practice Address - Phone:561-870-2798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health