Provider Demographics
NPI:1255507562
Name:DIAL-A-NURSE OF FT MYERS REGISTRY, INC.
Entity Type:Organization
Organization Name:DIAL-A-NURSE OF FT MYERS REGISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLFENDALE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:239-939-1228
Mailing Address - Street 1:DIAL-A-NURSE OF FORT MYERS REGISTRY, INC.
Mailing Address - Street 2:2180 W. FIRST ST. STE. 510
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DIAL-A-NURSE OF FORT MYERS REGISTRY, INC.
Practice Address - Street 2:2180 W. FIRST ST. STE. 510
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:239-939-1228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211116251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211116OtherAHCA
FL678475500Medicaid