Provider Demographics
NPI:1235179607
Name:M.D. HOME HEALTH, LLC
Entity Type:Organization
Organization Name:M.D. HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, RRT
Authorized Official - Phone:561-689-0445
Mailing Address - Street 1:580 VILLAGE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1953
Mailing Address - Country:US
Mailing Address - Phone:561-689-0445
Mailing Address - Fax:561-689-0415
Practice Address - Street 1:580 VILLAGE BLVD STE 315
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1953
Practice Address - Country:US
Practice Address - Phone:561-689-0445
Practice Address - Fax:561-689-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992400251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651363800Medicaid