Provider Demographics
NPI:1235722117
Name:DYNAMIC CAREGIVERS
Entity Type:Organization
Organization Name:DYNAMIC CAREGIVERS
Other - Org Name:DYNAMIC CAREGIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:IKOTIDEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-335-7787
Mailing Address - Street 1:21 COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4902
Mailing Address - Country:US
Mailing Address - Phone:908-968-0443
Mailing Address - Fax:
Practice Address - Street 1:21 COVERED BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4902
Practice Address - Country:US
Practice Address - Phone:240-476-8875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care